A diagnosis of GERD should be made by your physician. Diagnoses can often be made based on the presentation of common symptoms, especially in patients with more mild cases of GERD. However, the diagnosis of more complicated GERD can be tricky given the variety of symptoms and manifestations. There are a number of diagnostic tools a physician may use to diagnose GERD:
EGD (Esophagogastroduodenoscopy or Endoscopy):
EGD is performed to examine the esophagus, the gastroesophageal junction and the stomach. It is also helpful in establishing the presence and severity of erosive esophagitis. The procedure involves passing a flexible, lighted video scope through the mouth, down the esophagus and into the stomach. EGD procedures are normally quick and painless. Patients are generally asked not to eat or drink anything prior. Due to sedation used during the procedure, patients are often advised to arrange transportation to and from the appointment. Consult your physician for more specific guidance on what to do before and after the procedure.
Upper GI Series (Barium Swallow or Esophagram):
An upper GI series can help define anatomic abnormalities such as a hiatal hernia, blockages, inflammation of the esophagus and free reflux. It is primarily used to rule out esophageal disorders such as achalasia, which may cause reflux-like symptoms. A barium swallow involves the patient ingesting a solution that can be seen via x-ray. Patients need to have an empty stomach for this procedure but, because it is done without sedation, may drive themselves to and from the test. The test typically takes about 30 minutes.
The procedure examines esophageal motility by assessing the strength and coordination of muscle contractions, as well as the relaxation and coordination of the upper and lower esophageal sphincters. Manometry involves a small tube passed through the nose into the esophagus. Numbing medication is given to reduce discomfort but the patient is not sedated. The test usually takes 30-45 minutes and the patient is asked to swallow multiple times during the test.
pH monitoring provides a way for physicians to measure the severity of acid exposure in the esophagus. The study can be done using one of two methods. The first involves inserting a small tube through the nose and placing it in the back of the patient’s throat for 24-48 hours. The device is visible during the test and should not get wet. The second method involves a small electronic capsule that is introduced through the patient’s mouth, is attached to the esophagus and remains in place for 48 hours. Most patients do not notice the capsule. The capsule will fall off and pass on its own through the GI tract within a few days. Finally, patients are often asked to keep a diary to document when they eat, sleep or experience symptoms.
Impedance involves a small tube passed through the patient’s nose into the esophagus. The tube is left in place for approximately 24 hours to measure how much reflux is occurring, whether or not the reflux is acidic and how symptoms correlate with reflux. The device is placed without sedation and cannot get wet. It also has buttons for events such as eating, drinking, sleeping and for certain symptoms of reflux.
Patient history surveys:
There are a number of surveys commonly used to understand patient symptoms and identify GERD. It is likely that your doctor will use one as part of a standard workup if GERD is suspected. One such test is the GERD-HRQL (GERD - Health Related Quality of Life Survey).
Inherent risks associated with the diagnostic procedures described should be discussed with your physician.