**4. Clinical usefulness**

In what clinical conditions is it correct to perform these tests?

For standard esophageal manometry or HR esophageal manometry and reflux monitoring recent guidelines have given clear and shared indications [3, 4]. The utility of esophageal manometry in clinical practice is to accurately define esophageal motor function, to identify abnormal motor function, and to establish a treatment plan based on motor abnormalities, in patients with dysphagia, chest pain or in GERD patients before surgery.

Reflux testing has generally no indication in the majority of patients with typical GERD symptoms (i.e., heartburn and/or regurgitation) who have adequate symptom relief with medical therapy. The role of reflux monitoring is more important in patients with reflux symptoms and without endoscopic mucosal breaks, in whom an objective diagnostic test to define their disease is more likely to be needed. The prolonged reflux monitoring with pH-impedance catheter actually represents the most sensitive tool to document the role of reflux in patients with GERD symptoms. A further indication for reflux testing is represented by belching disorders and one of the most common use of reflux monitoring is the evaluation of patients with persistent typical GERD symptoms despite medical therapy, when refractory heartburn can be defined as the presence of heartburn that does not respond to at least 8-weeks of double-dose acid suppressing medications [4]. Furthermore it's recommended the evaluation of patients with esophageal symptoms suggestive for GERD before surgery, to confirm the reflux and the evaluation of children with symptoms suggestive for GERD (particularly in case of neurological symptoms and low growth).

As regards gastro-jejunal functional tests, there are no guidelines or consensus, but, extrapolating the data from the literature, we can consider these data useful in:


*Gastrointestinal Physiopathological Testing for Upper GI Functional Disorders DOI: http://dx.doi.org/10.5772/intechopen.97550*


### **5. Conclusions**

The gastrointestinal functional tests represent the study modalities of esophageal-gastric motility and intestine, useful for the diagnostic definition and therapeutic management of functional gastric and intestinal disorders. These diseases affect a large proportion of the world population, compromise the quality of life and cause significant health care costs. It is important to underline that functional tests must always be preceded by a careful clinical evaluation that excludes other etiologies. In general, investigations on intestinal motility should be reserved for patients with symptoms correlated to motor alterations that greatly influence the quality of life, nutrition and productivity, as they are justified only if a result can be expected that influences the clinical management of the patient [36].

### **Author details**

Edda Battaglia\*, Maria Luisa Niola, Valentina Boano, Chiara M.C. Elia, Carlo Sguazzini and Mario Grassini Physiopathology and Manometry Section, Gastroenterology and Endoscopy Unit, Cardinal Massaia Hospital, ASL AT, Asti, Italy

\*Address all correspondence to: edda.battaglia@gmail.com

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
