Q1. CORRECT ANSWER: A
In patients with a good response to anti-reflux surgery who develop new dysphagia, an upper endoscopy is the test of choice. This will evaluate the structural integrity of the fundoplication, and evaluate for disruption and paraesophageal herniation. The esophagus can be inspected for esophagitis, and dilation of the fundoplication site can be performed. In the absence of heartburn or the original reflux symptoms, empiric acid suppression is not expected to improve the dysphagia. If the endoscopy is negative, esophageal manometry and barium swallow are the next studies of value. A pH study off PPI therapy is performed if recurrent reflux is suspected that does not respond to anti-reflux medications.
1. Johnson D.A., Younes Z., Hogan W.J. Endoscopic assessment of hiatal hernia repair. Gastrointest Endosc. 2000;52(5):650-9.