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 Points to Consider
- MII-pH monitoring is recommended as the best available tool for diagnosing GERD, especially before surgery, as it provides a comprehensive assessment of acid reflux and its correlation with symptoms 1.
- Endoscopy should also be performed to rule out GERD complications, such as esophagitis, strictures, or Barrett's esophagus, and to assess the severity of reflux-related damage 1.
- Other tests, such as manometry, gastro-oesophageal scintigraphy, and EndoFlip, may be useful prior to considering surgery, but there is currently limited evidence about their role 1.
- The diagnosis of GERD is based on the clinical context and the overall results of performed studies, and a correct diagnosis is mandatory before intensifying medical therapy or planning surgery 1.
Investigation Details
- MII-pH monitoring over 24h is a crucial investigation for diagnosing GERD, as it measures the frequency and duration of acid reflux episodes and their correlation with symptoms.
- Endoscopy is also essential for assessing the severity of reflux-related damage and identifying complications, and it provides valuable information for surgical planning.
- The choice of investigation should be based on the individual patient's needs and the clinical context, and the results should be interpreted in conjunction with the patient's symptoms and medical history.
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 function tests, including pH monitoring and manometry, 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: