A 40-year-old woman complains of heartburn located in the epigastic and retrosternal areas. She also has symptoms of regurgitation. Endoscopy shows erythema of the esophagus consistent with reflux esophagitis. The patient has tried conservative measures, including PPIs with no improvement in symptoms. Which of the following is TRUE?

Conservative treatment of GERD includes lifestyle modifications (e.g., smoking cessation, decreased caffeine intake, avoidance of large meals before lying down, elevation of the head of the bed, and avoidance of constrictive clothing). PPI's are very effective if nonoperative management fails, surgical intervention should be considered. Preoperative evaluation includes manometry, 24-hour pH test and esophagogram, in addition to endoscopy. Manometry evaluates the LES resting pressure and effectiveness of peristalsis. The 24-hour pH test is the gold standard for diagnosing and quantifying acid reflux. Esophagogram shows the external anatomy of the esophagus and proximal stomach, as well as demonstrating the presence of a hiatal hernia. Nissen fundoplication is a 360deg gastric wrap. It can be performed as an open or laparoscopic procedure. It is the most common operation performed for GERD. Partial fundoplications (e.g., Thal, Dor, Toupet) are done if esophageal motility is poor.