Which patients with GERD require further work up? What do the tests evaluate or attempt to rule out?,”Long-standing or atypical symptoms. Recurrence of dz post medical therapy cessation. Unrelieved sx with maximal PPI dose. R/o malacious dyspepsia.1) Manometry & 24-hour pH monitoring (first line) – confirm dx and severity, r/o achalasia and LE spasm, evaluate peristalsis and LES competency2) Endoscopy – confirm dx, biopsy

Which patients with GERD require further work up? What do the tests evaluate or attempt to rule out?,”Long-standing or atypical symptoms. Recurrence of dz post medical therapy cessation. Unrelieved sx with maximal PPI dose. R/o malacious dyspepsia.1) Manometry & 24-hour pH monitoring (first line) – confirm dx and severity, r/o achalasia and LE spasm, evaluate peristalsis and LES competency2) Endoscopy – confirm dx, biopsy

assess for erosive esophagitis or Barretts3) Barium esophagogram – r/o hiatus hernia and gastric outlet obstruction4) Pharyngeal pH monitoring – confirm silent aspiration”