QuestionSBA
QuestionChoice
A contrast study may help to clarify the diagnosis and show strictures or dysmotility, but is not indicated as the OGD has showed a simple sliding hernia.
10028240
e
Arrange for a barium contrast study
QuestionChoice
Initiating a proton pump inhibitor (e.g. Omeprazole) would be the most appropriate next step, as the patient has already tried conservative management for her reflux symptoms. PPIs provide symptomatic relief and help prevent complications e.g. stricturing and Barrett's oesophagus.
10028236
a
Prescribe a proton pump inhibitor
QuestionChoice
Oesophageal manometry studies may help to provide more information regarding oesophageal manometry, but would usually take place if surgery is being considered. In the first instance, medical management should be attempted.
10028239
d
Arrange oesophageal manometry studies
QuestionChoice
A surgical procedure may be required if symptoms are refractory to medical management, but this should be tried first.
10028237
b
Refer for Nissen fundoplication
QuestionChoice
A Heller cardiomyotomy is used in the management of achalasia, not hiatus hernias.
10028238
c
Refer for Heller cardiomyotomy
Concept
Chapter
2693
4007
Hiatus hernia management
Topic
136
Gastroenterology
18045
A sliding hiatus hernia occurs when part of the stomach pushes up through the diaphragm into the chest, and PPIs (proton pump inhibitors) are often used to reduce stomach acid, alleviating symptoms such as heartburn and reflux associated with this condition.
A 53-year-old woman is referred on the two-week-wait pathway for an oesophagogastroduodenoscopy (OGD) for persistent reflux symptoms, which have not responded to lifestyle modification.

The OGD reports appearances consistent with a sliding hiatus hernia, with no concerns for malignancy.

What is the next most appropriate step?
a