Esophageal manometry and pH monitoring - Gostroenterologists' adherence to published guidelines

Goals: To determine whether gastroenterologists use esophageal manometry (EM) and esophageal pH recording (pHR) in accordance with published guidelines. Study: Questionnaires were mailed to 900 randomly selected gastroenterologists nationwide. Each questionnaire requested demographic information and contained 11 case scenario-based questions, followed by a choice of management options. Results: A total of 275 completed questionnaires (30.6%) were returned. 63.6% and 64.4% of respondents were aware of published guidelines regarding the use of EM and pHR, respectively. The majority of respondents ordered EM appropriately: 1) to confirm a suspected diagnosis of achalasia (97.1%); 2) to establish a diagnosis of connective tissue disease (89.7%); 3) as part of the preoperative evaluation for anti-reflux surgery (74.6%); and 4) to ensure the proper placement of pH probes (69.4%). EM was rarely ordered for the initial workup of noncardiac chest pain. The majority of responding gastroenterologists would order pHR for the evaluation of: 1) endoscopy-negative patients being considered for anti-reflux surgery (79.1%); 2) patients with recurrent GERD symptoms after anti-reflux surgery (62.5%); 3) endoscopy-negative patients with GERD symptoms refractory to proton pump inhibitor (PPI) therapy; and 4) patients with extraesophageal manifestations of GERD that are refractory to PPI therapy (88.7%). Conclusions: The majority of gastroenterologists in our study order EM and pHR in accordance with published guidelines. However, EM appears to be used less than expected for preoperative evaluation before anti-reflux surgery and for ensuring the proper placement of pH probes. In addition, the use of pHR to evaluate persistent GERD symptoms after anti-reflux surgery was less than anticipated.