Gastroesophageal Reflux Disease (GERD)

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Diagnosis

To diagnose GERD, the physician takes a family and personal medical history, and performs a physical examination and diagnostic tests. The physician evaluates the patient's symptoms and the pattern of the symptoms (e.g., symptoms may be worse after a certain type of meal) and may suggest over-the-counter or prescription medications and lifestyle changes.

If symptoms persist or worsen, the patient should see a specialist in digestive disorders (gastroenterologist).

Several types of diagnostic tests may be used to diagnose GERD. In an endoscopy, the patient is sedated and the physician examines the esophagus and stomach through a lighted tube inserted through the patient’s nose. The tube often has a miniature camera attached to takes pictures for further analysis. Tissue samples can also be removed during this procedure.

Endoscopy can be used to diagnose peptic ulcers, esophagitis, and Barrett's esophagus; however, it may not show abnormalities in all patients who have GERD.

In a barium x-ray, the patient drinks a substance that gives physicians a better view of the esophagus, stomach, and upper intestine (duodenum) upon x-ray. This test, which can show the extent of damage in the esophagus, may be used to diagnose a hiatal hernia, stricture, or growth.

Ambulatory acid (pH) tests detect reflux and can determine the degree of the condition. These tests come in two types. In a standard tube test the throat is numbed and a tube with a probe attached is inserted into the esophagus through the nose and a computer is set up on the other end of the tube. Usually, the probe is placed right above the lower esophageal sphincter. In some cases, a second probe is placed higher in the esophagus.

The patient then wears the computer around the waist or over the shoulder on a strap and goes through his or her normal everyday activities. The computer measures the amount of acid reflux and the physician analyzes the information.

A Bravo pH probe test is similar to the standard tube test, but is considered more comfortable for many patients. In this test, the probe is inserted during an endoscopy, sends information about acid reflux through a computer, and passes through the patient’s system in a couple of days. Esophageal impedance tests are similar to the standard pH test, but they measure refluxed gases and liquids rather than acids.

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