Diagnosing Reflux Disease

 

An accurate diagnosis of uncomplicated gastroesophageal reflux disease (GERD) can usually be made without expensive tests.

Because GERD has fairly characteristic symptoms, a complete history of the severity and frequency of heartburn or other symptoms along with actions that cause relief is usually enough for a doctor to make an initial diagnosis.

In severe cases, situations where traditional medical therapy has not been effective, or where symptoms such as bleeding and difficulty swallowing are compounding GERD, more definitive diagnostic tests are required.

Upper Endoscopy: An endoscope is a thin flexible tube with a tiny video camera at the end of it. The tube is passed through the mouth of the sedated patient and into the esophagus allowing the doctor to see the esophageal wall and signs of irritation or ulceration from exposure to stomach acid. Using the endoscope, the doctor can also take tissue samples or biopsies for additional testing. Upper endoscopy is also called esophago-gastro-duodenoscopy or EGD.

Barium Studies: After drinking a chalky liquid containing barium,a series of x-rays are used to look for abnormalities in the digestive tract. The barium coats the walls of the esophagus and stomach allowing the doctor to identify problems such as narrowing of the esophagus, ulcers, erosions, and hiatal hernia. The test is often called an upper GI series.

pH monitoring: Esophageal pH monitoring measures the amount of acid in the esophagus and how long it stays there. It is helpful in determining severity of reflux, effectiveness of treatment and for relating confusing symptoms to episodes of reflux. During the test, a tiny sensor at the end of a thin tube is passed through the nose and into the esophagus. The tube exits the nose and is folded back behind the ear and attaches to a recording device worn on the patient’s belt. Over a 24 hour period, the acidity in the esophagus is measured.

A newer method of pH monitoring attaches a tiny capsule-sized transmitter to the wall of the esophagus. The capsule transmits information for up to 48 hours to a small pager sized recorder worn by the patient. Eventually the capsule breaks away and is eliminated normally through the digestive tract. This method is more comfortable for the patient than the catheter method and normal activity is easier without a tube protruding from the nose.

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