ROSH Gastrointestinal Practice Exam

What diagnostic method would likely aid in the clinical diagnosis of gastroesophageal reflux disease (GERD)?

1. Esophagogastroduodenoscopy

2. HIDA scan

3. High resolution manometry

4. Proton pump inhibitor trial

The correct answer is: Proton pump inhibitor trial

A proton pump inhibitor (PPI) trial is considered a valuable diagnostic method for gastroesophageal reflux disease (GERD) due to its ability to provide therapeutic information. In practice, patients with suspected GERD are often started on a trial of PPIs, as symptom relief following this treatment can be indicative of the condition. If a patient's symptoms improve significantly with PPI therapy, it supports the diagnosis of GERD. This method is particularly useful because it not only aids in diagnosis but also serves as a practical treatment approach. Other diagnostic modalities may have roles in the evaluation of GERD. For instance, esophagogastroduodenoscopy allows direct visualization of the esophagus and can identify complications such as esophagitis or Barrett's esophagus but does not directly diagnose GERD. Similarly, high-resolution manometry assesses esophageal motility and can help in understanding the function of the esophagus but is not primarily a diagnostic test for GERD itself. A HIDA scan is unrelated to GERD and is used for evaluating the liver, gallbladder, and bile ducts. Hence, the PPI trial stands out as a straightforward and effective way to both assess and manage patients suspected of having GERD.