Oesphageal hiatal hernia can be diagnosed best on:
a. Endoscopy is an essential step in the evaluation of patients with GERD who are being considered for operative intervention.
b. The value of the study is in its ability to exclude other diseases, especially a tumor, and to document the presence of peptic esophageal injury.
c. The degree of injury can be measured using a scoring system such as the Savary-Miller interpretation (1, indicates erythema; 2, linear ulceration; 3, confluent ulceration; and 4, stricture). The extreme of mucosal injury is Barrett's esophagus. Biopsy samples are taken to confirm the metaplastic transformation and to exclude dysplasia.
d. The endoscope has been used to grade the so-called flap valve. This is interpreted on a retroflexed view of the gastroesophageal junction.
e. The flap valve is graded from 1 to 4, with 4 being a completely patulous junction with the lumen of the esophagus in full view from the body of the stomach.
b. The manometry catheter is a flexible tube with pressure-sensing devices (water perfused or solid state) arranged at 5-cm intervals.
c. The upper esophageal sphincter is notoriously difficult to analyze because it migrates during the cervical phase of swallowing.
e. The pertinent information to be gained from the manometry tracings concerns the function of the LES and the esophageal body.
a. The gold standard for diagnosing and quantifying acid reflux is the 24-hour pH test.
b. The study is performed by placing a thin catheter containing one or more solid-state electrodes in the esophagus