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Guidelines
British Society of Gastroenterology guidelines for oesophageal manometry and oesophageal reflux monitoring
  1. Nigel J Trudgill1,
  2. Daniel Sifrim2,
  3. Rami Sweis3,
  4. Mark Fullard4,
  5. Kumar Basu5,
  6. Mimi McCord6,
  7. Michael Booth7,
  8. John Hayman8,
  9. Guy Boeckxstaens9,
  10. Brian T Johnston10,
  11. Nicola Ager8,
  12. John De Caestecker11
  1. 1 Sandwell and West Birmingham Hospitals NHS Trust, West Bomwich, UK
  2. 2 Centre of Gastroenterology Research, Queen Mary University London, London, UK
  3. 3 University College London Hospitals NHS Foundation Trust, London, UK
  4. 4 West Hertfordshire Hospitals NHS Trust, Watford, Hertfordshire, UK
  5. 5 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  6. 6 Heartburn Cancer UK, Baingstoke, UK
  7. 7 Royal Berkshire NHS Foundation Trust, Reading, UK
  8. 8 Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
  9. 9 Gastroenterology, University Hospital, KU Leuven, Leuven, Belgium
  10. 10 Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK
  11. 11 University Hospitals of Leicester NHS Trust, Leicester, UK
  1. Correspondence to Dr Nigel J Trudgill; nigel.trudgill{at}nhs.net

Abstract

These guidelines on oesophageal manometry and gastro-oesophageal reflux monitoring supersede those produced in 2006. Since 2006 there have been significant technological advances, in particular, the development of high resolution manometry (HRM) and oesophageal impedance monitoring. The guidelines were developed by a guideline development group of patients and representatives of all the relevant professional groups using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. A systematic literature search was performed and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) tool was used to evaluate the quality of evidence and decide on the strength of the recommendations made. Key strong recommendations are made regarding the benefit of: (i) HRM over standard manometry in the investigation of dysphagia and, in particular, in characterising achalasia, (ii) adjunctive testing with larger volumes of water or solids during HRM, (iii) oesophageal manometry prior to antireflux surgery, (iv) pH/impedance monitoring in patients with reflux symptoms not responding to high dose proton pump inhibitors and (v) pH monitoring in all patients with reflux symptoms responsive to proton pump inhibitors in whom surgery is planned, but combined pH/impedance monitoring in those not responsive to proton pump inhibitors in whom surgery is planned. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG.

  • manometry
  • ph monitoring
  • oesophageal ph monitoring
  • oesophageal motility disorder

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/gutjnl-2018-318115

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    Footnotes

    • Contributors Contributorship – All authors critically reviewed the final guideline manuscript. NA undertook the literature searches. NJT, JDC, JH, KB, DS, RS, MB, MF, GB and BTJ reviewed the search results, formulated the PICO statements, voted on the statements during the guideline formulation and drafted the guidelines.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests RS: Dr Falk, advisory board and symposium sponsor; Given, honoraria for speaker’s fees. DS: Sandhill/Diversatech and Jinshan-Omon, consultancy work, research grants and equipment; Given, advisory board. JDC: trustee for FORT patient support group. KB: Reckitt Benckiser, honoraria for speaker’s fees.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Patient consent for publication Not required.