Refractory gastro-oesophageal reflux disease — ESEGH MCQ
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Correct answer: B — Off-PPI ambulatory reflux monitoring plus high-resolution manometry
The best answer is “Off-PPI ambulatory reflux monitoring plus high-resolution manometry”. Reflux monitoring confirms pathological exposure, while manometry excludes achalasia and informs operative planning. “Proceed to surgery on symptoms alone” is less appropriate because fundoplication requires objective confirmation and exclusion of major motility disease “Barium swallow alone” is less appropriate because anatomical imaging neither quantifies reflux nor fully characterises motility “Faecal calprotectin and H. pylori serology” is less appropriate because these tests do not establish GORD suitability for surgery “On-PPI symptom review without physiological testing” is less appropriate because unproven disease should be established off therapy before an irreversible intervention
Reference: BSG oesophageal manometry and reflux-monitoring guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC6839728/