How Gastroesophageal Reflux Disease (GERD) Is Diagnosed

When you have the telltale symptoms of heartburn and regurgitation, gastroesophageal reflux disease (GERD) can often be diagnosed with just a physical examination and a review of a detailed history of your symptoms. However, if you don't, the symptoms you do have aren't getting any better with treatment, or your doctor wants to check for potential complications, you may have testing such as an upper endoscopy, an ambulatory acid (pH) monitoring examination, esophageal manometry, or a barium swallow radiograph done.

GERD diagnosis
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Diagnosis by Treatment

Because GERD can present with classic symptoms that may all but prove to a physician that its the condition that is affecting you, some doctors may consider coming to a diagnosis by treating you right from the start.

Your doctor may put you on a proton pump inhibitor on a trial basis to see if your symptoms are controlled with the medication. Getting relief can be enough for a doctor to say you, indeed, have GERD. If you don't, he or she may consider running some tests.

Tests and Procedures

If your doctor decides to do tests to confirm that you have GERD, rule out other conditions (like ulcers or tumors), or to check for complications that may result from GERD, he or she may opt for one of the following. Depending on your circumstances and test results, you may have more than one.

Upper Endoscopy

Upper endoscopy is performed in a hospital or an outpatient facility. Beforehand, you will receive a sedative to keep you relaxed throughout the procedure. Your doctor will spray your throat to numb it and slide a thin, flexible plastic tube called an endoscope down your throat.

A tiny camera and light in the endoscope allow your doctor to see the surface of your esophagus and search for abnormalities. During the procedure, your doctor may also perform a biopsy so that a very small piece of tissue can be tested for complications like Barrett's esophagus.

If you have had moderate to severe symptoms and this procedure reveals any injury to your esophagus, no other tests are usually needed to confirm GERD.

Ambulatory Acid (pH) Monitoring Examination

In an outpatient center, a doctor puts a tiny tube through your nose or mouth into your esophagus, which will stay there for 24 hours. The other end of the tube connects to a small monitor. Once this is in place, you are sent home. When and how much acid comes up into your esophagus is measured and recorded as you go about your normal activities.

An ambulatory acid monitor is useful when you have GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux. This test is considered the most accurate to detect acid reflux.

Another form of pH monitoring is done with a capsule placed in your esophagus instead of a tube. The capsule wirelessly transmits acid measurements to a receiver you wear on your waistband. You also keep track of your symptoms by pushing certain buttons on the receiver and keeping a diary of activities such as when you eat and when you lie down.

Esophageal Manometry

This test measures the contractions in your esophagus when you swallow. It can show if your GERD symptoms are due to your sphincter muscle being weak and identify other issues with your esophagus that might be causing your symptoms instead of GERD.

It's done by numbing your throat and then placing a thin tube through your nose into your stomach. The tube is then pulled into your esophagus as you swallow while a computer takes measurements and records the contractions your esophagus makes in different areas. This can be done in your doctor's office.

Imaging

Your doctor may want to look at your upper gastrointestinal (GI) tract, especially if he or she suspects that you have a hiatal hernia or an issue with your esophagus.

Barium Swallow Radiograph

This test is done at an outpatient center or a hospital and uses X-rays of your upper GI tract to help spot abnormalities, though it can't show GERD. During this test, you'll sit or stand in front of an x-ray machine and drink a thick, chalky barium solution as X-rays are taken so your doctor can see how the barium moves through your mouth and esophagus. You may also drink a thinner barium solution and/or swallow a barium pill while pictures are again taken.

After the test, you may feel bloated or nauseous, and you may have light-colored stools from the barium. Mild esophageal irritation will not appear on this test, although narrowing (strictures) of the esophagus, ulcers, and a hiatal hernia will.

Differential Diagnoses

There are several disorders that have symptoms that can overlap with GERD. Fortunately, all of these conditions can be distinguished from GERD using the same tests described above.

Esophagitis

GERD can, in the long-term, cause esophagitis (inflammation in your esophagus). Esophagitis can also be due to:

  • Medications: Certain drugs (tetracycline and doxycycline, for example) can be caustic and directly cause esophagitis when they get caught and begin to dissolve in the esophagus; why it's important to swallow your pills with plenty of liquid. Other medicines damage the protective barrier in the stomach and the esophagus, and injury can result from the resultant exposure to stomach acid. Aspirin, Motrin (ibuprofen), and Aleve (naproxen sodium) are some examples. Finally, Fosamax (alendronate) and related drugs can cause severe esophagitis and other GI injury if not taken correctly, though experts don't know why. Quinidine is associated with inflammation that can be bad enough to cause lesions that mimic esophageal cancer, though this is rare.
  • A higher than normal concentration of white blood cells in your esophagus caused by an allergic reaction, acid reflux, or both (eosinophilic esophagitis)
  • A viral, bacterial, or fungal infection in your esophagus

Your doctor may use an upper endoscopy with a tissue biopsy to diagnose esophagitis.

Esophageal Issues

If you experience difficulty swallowing, a symptom of GERD, this could instead be due to esophageal rings or webs, an esophageal motility disorder, an esophageal stricture, or even esophageal cancer. Like esophagitis, these issues can also be distinguished from GERD with an upper endoscopy with a tissue biopsy.

Reflux Hypersensitivity and Functional Heartburn

Having frequent heartburn can be because of reflux hypersensitivity or functional heartburn rather than GERD. These disorders are essentially the same thing with only slight nuances, and are quite common. 

Reflux hypersensitivity has the same symptoms as GERD, but an endoscopy will come out normal, and the commonly used medications for heartburn usually won't help. The same can be said for functional heartburn, but its symptoms are not caused by reflux like they are with reflux hypersensitivity.

These are typically diagnosed with a patient has symptoms that are not explained by testing.

How Gastroesophageal Reflux Disease (GERD) Is Treated
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