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What is A 45 year old lady is having persistent reflux symptoms. Most accurate investigations in establishing diagnosis before surgical treatment is and explain in detail?
GERD is often associated with hiatus hernia type IClinical featuresInvestigationsClassical traid: reterosternal burning pain, epigastric pain and regurgitation.HeaburnsRegurgitationAbdominal painCoughDysphagia for solidsBelchingBloatingManometry for measuring LES tone24 hrs PH monitoringEsophagogram TreatmentLifestyle modifications: cessation of smoking, decreased caffeine intake and avoidance of large meal at nightMedical management: double dose of PPI'SSurgical therapy: laparoscopic Nissen's fundoplication, modern fundoplication, 3600 floppy fundoplication (Refer: Sabiston's Textbook of Surgery, 19th edition, pg no: 1081)