Best test to diagnose gastroesophageal reflux disease and quantify acid output:

Ans. d. 24 hours pH monitoring Best test to diagnose gastroesophageal reflux disease and quantify acid output is 24 hours pH monitoring.Gastro-Esophageal Reflux Disease (GERD)* Classical triad of symptoms is retrosternal burning pain, epigastric pain and regurgitation0.* GERD is associated with complications such as esophageal ulcerations (5%), peptic strictures (4-20%), and Barrett's esophagus (8-20%).Pathophysiology:LES has the primary role of preventing reflux into the esophagus.Factors contributing to the high-pressure zone in the lower esophagus* Intrinsic musculature0 of the distal esophagus which are in a state of tonic contraction* Sling fibers of the cardiadeg which are at the same anatomic depth of the circular muscle fibers of the esophagus but are oriented in a different direction* Diaphragm: during inspiration the anteroposterior diameter of the crural opening is decreased, compressing the esophagus and increasing the measured pressure at the LES* Transmitted pressure0 of the abdominal cavityGastro-Esophageal Reflux Disease (GERD)* GERD is often associated with a hiatal hernia (MC type is type I or sliding hernia)* A hiatal hernia is neither necessary nor sufficient to make the diagnosis of GERD, and the presence of such a hernia does not constitute an indication for operative correction*3.* Many patients with hiatal hernias do not have symptoms and do not require treatmentClinical Features:* Classical triad of symptoms is retrosternal burning pain, epigastric pain and regurgitation.* MC presentation of GERD: Long-standing history of heartburn and a shorter history of regurgitation* Symptoms of GERD: Heartburn (80%)*\ Regurgitation (54%), Abdominal pain (29%), Cough (27%), Dysphagia for solids (23%), Belching (15%), Bloating (15%), Aspiration (14%), Wheezing (7%).Diagnosis:* Endoscopy: Exclude other diseases, especially a tumor, and to document the presence of peptic esophageal injury. An essential step in the evaluation of GERD. who are being considered for operative intervention0.* Manometry: For information about the function of the esophageal body and LESdeg24-hour pH Monitoring* Gold standard for diagnosing and quantify ing acid reflux is the 24-hour pH test.* Information from the study: Total number of reflux episodes (pH<4), longest episode of reflux, number of episodes lasting >5 minutes, extent of reflux in the upright and supine position.* De.Meester score: An overall score is obtained with the use of a formula that assigns a weight to each item according to its capacity to cause esophageal injury.* DeMeester score needs to be <14.7deg.* Esophagograin: For evaluation of symptoms of GERD when an operation is contemplated or when the symptoms do not respond as expected. Presence and size of a hiatal hernia may be characterized.Treatment:Lifestyle modifications: Cessation of smoking, decreased caffeine intake, and avoidance of large meals before lying down*3Medical Management: Double dose of PPI is the initial approach* Compared with H, blockers, PPIs are more effective at healing esophageal ulceration secondary' to acid exposure.Indications of Surgical Therapy* Severe esophageal injury (ulcer, stricture, or Barrett's mucosa)* Incomplete resolution of symptoms or relapses while on medical therapy* Long duration of symptoms* Symptoms persist at a young age