Diseases and Conditions

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal Reflux Disease (GERD)

Diagnosis

The way that your clinician will diagnose you depends on your symptoms and how you respond to treatment.

If both heartburn and acid regurgitation are present and antacids seem to help, GERD can be diagnosed by your symptoms alone. If you have chest pain, antacids do not help you, or you have unusual symptoms such as bleeding or difficulty swallowing, your clinician may need to run tests to determine the cause of your symptoms.

Testing can help rule out other conditions that share the symptoms of GERD. These include infections and chemical esophagitis (irritation of the esophagus after exposure to certain chemicals or medications). The radiation that you might receive if you have cancer in the neck, chest, or head often causes injury and inflammation in the esophagus (esophagitis). Crohn's disease of the esophagus, angina, tumors, and ulcers are some other conditions that may feel like GERD. Your clinician may need to run tests to rule out these conditions before you are diagnosed with GERD.

There are several different kinds of tests that are used to check for GERD [Table 2].

Testing to diagnose GERD is not always necessary. For symptoms that can be serious or that are hard to relieve, your clinician may need to perform certain tests [Table 2].

Table 2.   Testing That May Be Done to Diagnose or Rule Out GERD
Name of test What it is How it's done
Barium swallow A type of x-ray used to identify severe inflammation or structural abnormalities of the esophagus. The patient drinks a barium-containing solution. The barium will show up on x-ray, allowing the clinician to spot problem areas in the esophagus.
Endoscopy A procedure in which a scope is inserted through the mouth into the esophagus, stomach, and possibly part of the bowel. Endoscopy is more accurate than a barium swallow in diagnosing GERD, but it is also more expensive and more difficult. A local anesthetic is sprayed into the throat and an endoscope (a thin, flexible plastic tube) is then inserted into the mouth and down the esophagus. A tiny camera in the endoscope shows the surface of the esophagus. Visible damage confirms a diagnosis of GERD. The absence of visible damage, however, does not rule out GERD. Occasionally a small section of tissue is removed for testing during an endoscopy (this is called a biopsy).
pH monitoring A probe measures the amount of acid backing up in the esophagus and the pattern of its occurrence throughout a 24-hour period. This test is useful for determining if respiratory symptoms, such as coughing or wheezing, are related to reflux in patients with unexplained asthma. A small tube is placed down through the nose and into the esophagus, where it stays for 24 hours while the patient goes about his or her normal day.
Because pH monitoring measures only acidic content, it cannot determine if other damaging digestive agents (such as bile or pancreatic enzymes) are backing up into the esophagus.
Esophageal manometry This test helps detect problems with movement of the esophagus and functioning of the lower esophageal sphincter by measuring pressures in the esophagus. Special tubing is passed through the nose or mouth and into the esophagus. Pressure readings are taken.