How is GERD diagnosed?
People who are thought to have GERD (gastro-esophageal reflux disease) can take medication to see what happens. If their symptoms improve, they probably have GERD. If there is no clear outcome, other examinations can be done.
A lot of people have heartburn after large meals. Occasional acid reflux is normal too. But very frequent, severe heartburn or acid reflux can be a sign of gastro-esophageal reflux disease, or GERD for short. In GERD, some of the stomach contents flow back into the food pipe because the entrance to the stomach doesn't close properly.
It is usually typical symptoms like these that make people seek medical advice. Sometimes people have an examination because of other symptoms, and then discover by chance that their food pipe is inflamed. The food pipe can become inflamed if the mucous membranes lining it are repeatedly exposed to acidic stomach juices.
Describing your symptoms in as much as possible is important when it comes to diagnosing GERD:
- What are the symptoms? Where exactly are they?
- How often do you have them?
- Do they occur after eating or when your stomach is empty?
- Do they get worse when you lie down?
This information can help the doctor to find out whether the symptoms are being caused by GERD or by something else.
GERD doesn't always cause obvious symptoms. For instance, someone might have GERD without having heartburn or acid reflux, or these symptoms may only be very infrequent or mild. Sometimes the main symptom is problems swallowing, a hoarse voice or a cough.
If it is thought that someone might have GERD, a PPI test can be done. This involves taking a proton pump inhibitor (PPI) for about two weeks. Proton pump inhibitors are drugs that reduce the production of stomach acid. If the medication relieves symptoms such as heartburn, then it is very likely that GERD is causing them. In that case, the treatment with proton pump inhibitors is typically continued.
What other kinds of tests are there?
Further tests are usually only necessary if
- the PPI test didn't lead to a noticeable improvement,
- there are symptoms that could be signs of esophageal cancer or narrowing of the food pipe, or
- there is reason to believe that other medical conditions could be causing the symptoms.
If the GERD is associated with bleeding in the bowel, extreme weight loss or regular vomiting, these symptoms could be signs of serious complications. Then further tests would be necessary too.
Further tests might include, in particular, an endoscopy and a pH test. Both of these tests can be done in an outpatient setting (without staying overnight in a hospital).
Endoscopy makes it possible to see changes in the lining of the food pipe, including inflammations, narrowing of the food pipe or Barrett’s esophagus. The procedure is carried out using an endoscope. This is a thin, flexible tube that has a tiny camera at the end of it. The endoscope is inserted through the nose or mouth and pushed down through the food pipe until it reaches the entrance of the stomach. The camera delivers pictures of the lining of the food pipe during the procedure. Small samples of tissue can be taken during an endoscopy too. This does not hurt.
This pH test measures how acidic the lower end of the food pipe is over a time period of at least 24 hours. To do so, the doctor inserts a thin tube into the nose and pushes it down until it reaches the end of the food pipe. The tube has a small portable measuring device attached to it, and is taped to your face in order to fix it in place. You can normally go home and return the next day to have the tube removed.
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Koop H, Fuchs KH, Labenz J, Lynen Jansen P, Messmann H, Miehlke S et al. Gastroösophageale Refluxkrankheit (S2k-Leitinie). AWMF-Registernr.: 021-013. May 2014.
Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet 2006; 367(9528): 2086-2100.
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