Gastrointestinal surgery: investigation before antireflux surgery: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: investigation before antireflux surgery

Sample item

A 40-year-old man has typical heartburn that has not responded to a full course of proton pump inhibitors. Upper gastrointestinal endoscopy is normal. Before considering an antireflux operation, which investigation best confirms pathological acid reflux?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. 24-hour pH monitoring

In patients with normal endoscopy being considered for surgery, ambulatory 24-hour pH monitoring objectively proves abnormal acid exposure. Manometry is also done before surgery, but to exclude achalasia and assess peristalsis rather than to prove reflux.

Option by option

  • A. Barium swallow study

    A barium swallow shows anatomy and may show a hernia, but it does not prove pathological reflux.

  • B. 24-hour pH monitoring (correct)

    Correct. Ambulatory pH monitoring quantifies oesophageal acid exposure and correlates it with symptoms.

  • C. Oesophageal manometry alone

    Manometry shows motility and sphincter pressure, not acid exposure.

  • D. Fasting serum gastrin

    Gastrin is raised in hypersecretory states and does not diagnose reflux.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, 24-hour pH monitoring. In patients with normal endoscopy being considered for surgery, ambulatory 24-hour pH monitoring objectively proves abnormal acid exposure.

Why is "Barium swallow study" not the answer?

A barium swallow shows anatomy and may show a hernia, but it does not prove pathological reflux.

Why is "Oesophageal manometry alone" not the answer?

Manometry shows motility and sphincter pressure, not acid exposure.

Why is "Fasting serum gastrin" not the answer?

Gastrin is raised in hypersecretory states and does not diagnose reflux.

What concept does this question test?

It tests Gastrointestinal surgery: investigation before antireflux surgery in General Surgery. Manometry is also done before surgery, but to exclude achalasia and assess peristalsis rather than to prove reflux.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: investigation before antireflux surgery?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.