<prompt> Gold standard test for diagnosing GERI:Ambulatory pH monitoringEsophageal manometryEndoscopyBarium Swallow  <response>: Ref: Harrisons Principles of Internal Medicine, 18th ed, pg 2428Explanation:GERD:Heartburn regurgitationCough, dental erosions, arrhythmias can occurComplications- Peptic stricture, Barrets esophagus , adenocarcinoma 20 fold higher in BarretsConfirmatory test is 24-48 hr pH monitoring to show pH4 for 5of durationSensitivity can be increased by impedence manometryEndoscopy can be normal in reflux many timesEsophageal manometry used to diagnose motility disorders-achalasia, diffuse esophageal spasmEndoscopic ultrasound ELS - to stage esophageal cancer, to diagnose dysplasia in Barrets for submucous tumors.Esophagitis - stricture - Barrets esophagus - adenocarcinoma50 of esophageal ca is adenocarcinomaEsophageal dysphagia: causesSchatzki ringWebGERDAchalasiaDESSclerodermaNeoplasmPeptic strictureEsophagitis- pill, infection, radiationCrohns, BehcetsBullous pemphigus, lichen planusSchatzki ring- Distal esophageal mucosal ring B ring with lumen diameter 13mm, causing intermittent dysphagia for solid foods ysteakhouse syndromeZenkers diverticulum- false, hypopharyngeal diverticula at the Killians triangle due to stenotic cricopharyngeus muscle upper esophageal sphincterBarium swallows inDES- corkscrew esophagusAchalasia-dilated esophagus, tapering at LES beak like appearanceTylosis plantaris, pluminer Vinson, Selenium, molybdenum, Zinc, Vit A deficiencies associated with esophageal cancerManometry- Most sensitive test for Achalasia 