Esophageal manometry is of limited value in the primary diagnosis
of GERD. Neither a decreased lower esophageal sphincter
pressure, nor the presence of a motility abnormality is specifi c
enough to make a diagnosis of GERD. Manometry should be used
to aid in placement of transnasal pH-impedance probes and is
recommended before consideration of antirefl ux surgery primarily
to rule out achalasia or severe hypomotility (scleroderma-like esophagus), conditions that would be contraindications to Nissen
fundoplication, but not to tailor the operation.