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Postfundoplication symptoms — ESEGH MCQ

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HardGastroesophageal Reflux DiseasePostfundoplication symptomsESEGH

A patient has recurrent regurgitation and dysphagia 8 months after fundoplication. Endoscopy shows no oesophagitis and an apparently intact wrap. What is the most useful next evaluation before further treatment?

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Correct answer: A — Manometry plus ambulatory reflux monitoring

Symptoms after antireflux surgery may reflect recurrent reflux, an obstructive wrap, dysmotility or a functional disorder. Endoscopy alone cannot distinguish these. High-resolution manometry evaluates outflow obstruction and motility; ambulatory pH or pH-impedance testing establishes whether reflux persists and whether symptoms are associated with reflux. Reoperation should not precede objective anatomical and physiological assessment.

Reference: BSG guideline for oesophageal manometry and reflux monitoring. https://www.bsg.org.uk/clinical-resource/british-society-of-gastroenterology-guidelines-for-oesophageal-manometry-and-oesophageal-reflux-monitoring