Heartburn and GERD

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Heartburn and GERD

How is GERD diagnosed?

Photo of a couple having breakfast

Doctors can often diagnose GERD (gastro-esophageal reflux disease) based on its typical symptoms. An examination of the inside of the stomach using endoscopy or the measurement of pH levels in the lower esophagus can also be carried out to confirm the .

A lot of people have heartburn after large meals. Occasional acid reflux is normal too. This is where stomach contents flow back up (regurgitate) into your throat and mouth. 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 opening 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.

What questions will the doctor ask?

Describing your symptoms in as much detail 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 symptoms are swallowing problems, a hoarse voice or a cough.

What other kinds of examinations are there?

If your doctor thinks you have GERD, they can confirm the by using gastroscopy. Experts particularly recommend doing that early on if:

  • there are signs of bleeding in your gastrointestinal tract, such as blood in stool,
  • you are vomiting frequently or have lost a lot of weight.
  • there are other symptoms that could be signs of esophageal cancer or narrowing of the food pipe, or
  • there are signs that another disease could be causing the symptoms.

If the endoscopy doesn't show clear results or if the symptoms don't improve despite treatment and changes to your diet, then the pH level in your lower esophagus is measured for 24 hours using a thin tube.

They can both be done in an outpatient setting (without staying overnight in a hospital).

Endoscopy

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 . This is a thin, flexible tube that has a tiny camera at the end of it. The typically enters your body through your mouth. The doctor can then examine the lining of your esophagus, stomach and duodenum using the video camera. Small samples of tissue can be taken during an endoscopy too. This doesn't hurt.

pH test

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 with a probe on it into your nose and pushes it down until it reaches the end of your esophagus. 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 probe removed.

Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis (S2k-Leitinie). AWMF-Registernr.: 021-013. Z Gastroenterol 2023; 61(7): 862-933.

Fox M, Forgacs I. Gastro-oesophageal reflux disease. BMJ 2006; 332(7533): 88-93.

Moayyedi P, Talley NJ. Gastro-oesophageal reflux disease. Lancet 2006; 367(9528): 2086-2100.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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How is GERD diagnosed?

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Updated on August 5, 2024

Next planned update: 2027

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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