• Tests

    The diagnosis of GERD is primarily made on the basis of symptoms. These are often present after meals or when lying down. Diagnosis can also be supported if the patient's symptoms respond to treatment directed to decreasing the acid production by the stomach. There are also several tests to evaluate the esophagus. Tests are done to rule out other disorders such as achalasia (a motility disorder), esophageal ulcers, stomach ulcers and cancers. 

    • Anesophagram and upper GI series is a test where you go to an x-ray facility and are asked to swallow barium which is a contrast material. X-rays are then taken as the barium is swallowed. The x-ray is helpful in determining if there is a complication of reflux such as an esophageal ulcer, a narrowing or stricture, a cancer of the esophagus or a motility disorder such as achalasia. It is not a test used to diagnose reflux.
      An x-ray can also exclude other diagnoses such as ulcers of the stomach or duodenum and cancers of the stomach. The x-ray is a good test but not as sensitive as a gastroscopy, explained below, and does not allow one to obtain biopsies, perform therapeutic procedures or identify the more subtle lining abnormalities of reflux.  
    • A gastroscopy is a where a camera is used to investigate the esophagus, stomach and duodenum which are part of the upper gastrointestinal tract beyond the stomach. This test may take only 10 minutes and you can go home after about one hour in the recovery room. Gastroscopy is performed at the hospital, or an outpatient facility. The scope is a long, thin, flexible tube. Although some people have the procedure without drugs, sedation is usually given through an IV. This is called conscious sedation and it is not a general anesthetic. The drugs can be very effective and people often may wake up after the test and say "when does the test start?". The gastroscope goes down the esophagus – not the air pipe – so breathing is not a problem. 
      In the majority of cases the esophagus appears normal in the setting of reflux. Some patients may have endoscopic evidence of esophagitis where there can be some redness, erosions that are superficial breaks and ulcers that are deeper breaks in the esophagus. Gastroscopy can also identify strictures or narrowings in the esophagus, Barrett's esophagus, cancers and stomach and duodenal ulcers. 
      Taking biopsies of the lining through the scope can be done during the test. If there is a narrowing within the esophagus that requires a dilatation or stretch, this can also be performed at the time of the scope. A balloon can be placed thru the scope and inflated at the level of the stricture. Or a guidewire can be placed thru the scope and subsequently a dilator can be passed over the guidewire to stretch the stricture. 
    • An espophageal motility study measures how strong the esophageal contractions are, and whether the esophageal waves are orderly or disordered, what the pressure of the lower esophageal sphincter is and does it relax appropriately. For this procedure, a tube is placed through the nose into the esophagus. The patient is then asked to swallow water. The study may be performed on some individuals who have problems swallowing their food and yet an obstructing lesion is not identified at gastroscopy. This study would be conducted prior esophageal surgery for reflux. 
    • A 24-hour pH test involves placing a tube through the nose and into the esophagus where it will stay for 24 hours. There is a sensor present in the end of the tube to measure the acidity and a small compact recorder that you wear on a belt. This test may be of value in individuals who have continual heartburn or voice problems in spite of medical therapy. It can indicate whether the medications have been effective in suppressing acid.

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