Gastroesophageal Reflux Disease
Topic overview
Drs. Jeffrey Ponsky and Michael Rosen discuss the diagnostic workup and management of gastroesophageal reflux disease. The conversation covers medical therapy with PPIs, diagnostic testing including EGD and esophageal manometry, and surgical intervention for refractory cases.
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Key takeaways
- EGD is essential to assess esophagitis severity and rule out Barrett's esophagus before escalating GERD treatment.
- Bravo pH study should be performed off PPI to accurately measure acid exposure and guide surgical decision-making.
- Esophageal manometry is mandatory prior to fundoplication to assess motility and prevent postoperative dysphagia.
- Refractory GERD after PPI trial warrants objective testing (EGD, pH study, manometry) before considering surgery.
- Fundoplication candidacy requires documented pathologic reflux and adequate esophageal peristalsis on preoperative workup.
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