Q:

When assessing gastroesophageal reflux disease by manometry each of the following statements is correct except one. Identify the incorrect one

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When assessing gastroesophageal reflux disease by manometry each of the following statements is correct except one. Identify the incorrect one.


  1. Absent or extremely low LES pressures have predictive value in identifying more severe reflux
  2. Peristaltic dysfunction increases with increasing severity of esophagitis.
  3. With established reflux disease the UES is hypertensive.
  4. Esophageal functional changes are worst in patients with a circumferential columnar-lined esophagus.
  5. Absence of peristalsis may be associated with more severe forms of reflux disease.

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C. With established reflux disease the UES is hypertensive.

DISCUSSION: In reflux disease when LES pressure is below 10 mm. Hg, manometry is too imprecise to identify a potential for significant reflux. If the pressure is less than 6 mm. Hg, this shows a reasonable high specificity as compared with abnormal reflux on pH testing. When LES pressure is extremely low or nonexistent, this identifies a more severe degree of reflux and a poorer prognosis for long-term medical therapy. In the esophageal body, active reflux esophagitis causes altered function. Failed peristalsis increases, and the contractions become weaker. Patients with a columnar-lined esophagus have the worst functional abnormalities. Although distention or acid perfusion in the proximal esophagus can produce a significant increase in UES resting pressure, there is at present no solid evidence relating UES resting pressures to active reflux disease.

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