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Diagnosing GERD

There are several different ways to diagnose GERD, including:

  • Barium swallow radiograph uses X-rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. With this test, you drink a solution and then X-rays are taken. The test will not detect mild irritation, although strictures — narrowing of the esophagus — and ulcers can be observed.

  • Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin, flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny camera, the endoscope allows the doctor to see the surface of the esophagus and search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.  The doctor also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus. The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other problems if infection or abnormal growths are not found.

  • pH monitoring examination involves the doctor either inserting a small tube into the esophagus or clipping a tiny device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus. This test can be useful if combined with a carefully completed diary — recording when, what and amounts the person eats — which allows the doctor to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.

  • Manometry determines how well the esophagus contracts and if it can move food in the right direction. Muscles that don’t work well in the esophagus can cause heartburn-like symptoms and may also affect the type of treatment that will work best for you.

  • Gastric Emptying Study is a test to determine how well the stomach empties. If food and acid stay in the stomach too long, stomach contents can reflux back into the esophagus and cause symptoms. During this test in the radiology department, patients are given a meal and then imaging is performed over the next few hours.

A completely accurate diagnostic test for GERD does not exist, and tests have not consistently shown that acid exposure to the lower esophagus directly correlates with damage to the lining.