What is the definitive investigation in GORD in pediatrics?

In the context of gastroesophageal reflux disease (GORD) in pediatrics, the definitive investigation is 24-hour pH monitoring. This test provides a direct and continuous measurement of acid exposure in the esophagus, helping to correlate symptoms with episodes of reflux. It is considered the gold standard for diagnosing GORD as it quantifies the frequency and duration of acid reflux episodes, which is essential for evaluating the severity of the condition and determining the most appropriate treatment strategy.

While an upper GI study with biopsy can provide information about structural abnormalities and inflammation, it does not give a comprehensive assessment of acid exposure over time. Throat swabs are not relevant for diagnosing GORD, as they are aimed at detecting infections rather than reflux. Esophageal manometry measures the motility of the esophagus but does not directly measure acid exposure or reflux episodes.