Acid reflux is prevented by all except:: (A) Long intra-abdominal esophagus, (B) Increased intra-abdominal pressure, (C) Right crus, (D) Increased intra thoracic pressure
Answer is D. Ans: d (Increased intra-thoracic pressure) Ref: Bailey, 24th ed, p. 999Intra-abdominal pressure compresses the intra-abdominal segment of LES and is probably the most important factor in preventing reflux.Dyspepsia with fatty foods is more common in GERD than gall stone disease.Diagnostic measurement in GERD24 hour pH recording- gold standard for diagnosisTransient lower esophageal sphincter relaxation (TLOSR) is the most important manometric finding.Treatment:Medical: PPI are most effectiveTilting the bed- head end elevationSurgical: Allison repair--not done nowNissen fundoplication- total- partialHill procedureBelsey Mark IV