From the Guidelines
The best investigation 24 hours before surgery for a Gastroesophageal Reflux Disease (GORD) case is MII-pH monitoring over 24h, as it is the best available tool for the diagnosis of GERD, according to the most recent guidelines 1.
Key Considerations
- A correct diagnosis of GERD is mandatory before intensifying medical therapy or planning surgery, and MII-pH monitoring is the most reliable method for this diagnosis.
- Endoscopy should always be performed to rule out GERD complications, and a Barium swallow should be conducted to rule out anatomical gastro-oesophageal alterations, especially before surgery or after a failed fundoplication.
- Other tests, such as manometry, gastro-oesophageal scintigraphy, and EndoFlip, might be useful prior to considering surgery, but there is currently limited evidence about their role.
Investigation Details
- MII-pH monitoring over 24h is the best available tool for the diagnosis of GERD, as stated in the international network on oesophageal atresia (inoea) consensus guidelines 1.
- The British Society of Gastroenterology guidelines also suggest that patients should ideally undergo a minimum of 24 hours of reflux monitoring, with a minimum of 16 hours of monitoring needed to obtain clinically useful data 1.
Clinical Context
- The diagnosis of GERD is based on the clinical context and the overall results of performed studies, and a comprehensive preoperative assessment is crucial to ensure the patient is optimized for anesthesia and surgery.
- Medication reconciliation, including proton pump inhibitors (PPIs), is important, and patients should fast for at least 6-8 hours before the procedure to reduce aspiration risk.
- A focused history and physical examination should be performed to assess for any recent changes in symptoms or new concerns, and to establish baseline values for postoperative comparison.
From the Research
Best Investigation for GORD Case 24 Hours Before Surgery
The best investigation 24 hours before surgery for a Gastroesophageal Reflux Disease (GORD) case is a topic of interest in the medical field.
- The investigation should accurately diagnose GORD and assess its severity.
- It should also help in selecting patients for antireflux surgery.
Options for Investigation
The options for investigation are:
- pH Monitoring
- Endoscopy
- Manometry
Evidence from Studies
Studies have shown that:
- pH monitoring is the most sensitive and specific diagnostic investigation for GORD 2.
- Esophageal manometry and pH monitoring are important in diagnosing GORD accurately 3.
- Combined multichannel intraluminal impedance pH monitoring (MII-pH) provides useful information for objective selection of patients for antireflux surgery 4.
- Ambulatory 24-h pH monitoring should be routinely performed in the preoperative work-up of patients suspected of having GORD to avoid unnecessary antireflux surgery 5.
Recommendation
Based on the evidence, the best investigation 24 hours before surgery for a GORD case is:
- pH Monitoring, specifically ambulatory 24-hour esophageal pH monitoring 2.
- This investigation measures increased esophageal exposure to gastric juice and provides a composite score that correlates with the degree of esophageal epithelial damage.
- It is also useful in assessing the severity of GORD and selecting patients for antireflux surgery 3, 4, 5.