Acid reflux, also known as gastroesophageal reflux disease (GERD), occurs when stomach acid frequently flows back into the esophagus, the tube connecting your mouth and stomach. This backward flow can irritate the esophageal lining, leading to uncomfortable symptoms. Accurate diagnosis of GERD guides effective treatment and helps prevent complications. Relying solely on symptoms is often insufficient, as testing provides insights into the condition’s cause and severity.
Initial Evaluation by a Doctor
The first step in diagnosing acid reflux involves a discussion with a doctor about a patient’s medical history and symptoms. The doctor will inquire about the frequency, severity, and specific triggers of symptoms, such as heartburn or regurgitation. This helps understand the pattern of reflux and its impact on daily life.
A physical examination may also be conducted, though it often yields normal results. This examination helps rule out other conditions with similar symptoms. A common initial diagnostic approach is an “acid suppression trial,” where the patient takes proton pump inhibitors (PPIs) for several weeks. Significant symptom improvement during this trial suggests GERD, guiding further management or indicating the need for additional testing if symptoms persist.
Endoscopy and Biopsy
An upper endoscopy, also known as esophagogastroduodenoscopy (EGD), is a common procedure to visualize the upper digestive tract. It involves inserting a thin, flexible tube with a camera, called an endoscope, down the throat to examine the lining of the esophagus, stomach, and the beginning of the small intestine (duodenum). This allows the doctor to observe inflammation, erosions, strictures (narrowing), or other changes like Barrett’s esophagus, a precancerous condition.
Before the procedure, patients need to fast for several hours to ensure the upper digestive tract is clear. During the endoscopy, sedation is administered for comfort. The endoscope sends images to an external monitor, allowing the doctor to inspect the internal structures for signs of acid damage.
A biopsy may be taken during the endoscopy by passing a small instrument through the endoscope to collect tiny tissue samples from the esophageal lining. These samples are then examined under a microscope by a pathologist. This microscopic analysis can detect cellular changes, inflammation not visible to the naked eye, or rule out other conditions, including certain types of cancer. The biopsy provides detailed information about tissue damage and helps confirm specific diagnoses.
Esophageal pH Monitoring
Esophageal pH monitoring measures acid exposure in the esophagus over 24 to 48 hours. This test is useful when symptoms are atypical, or when initial treatments or tests haven’t provided a clear diagnosis. It helps correlate symptoms with actual reflux episodes.
There are two types of pH monitoring: catheter-based and wireless. In catheter-based monitoring, a thin, flexible tube with sensors is passed through the nose and positioned in the esophagus, remaining there for about 24 hours to record acid and non-acid reflux events. The sensors transmit data to a portable recorder worn by the patient, who also logs symptoms and activities.
The wireless method, often using a Bravo capsule, involves placing a small, temporary capsule on the esophageal lining during an endoscopy. This capsule wirelessly transmits pH data to a receiver worn by the patient for up to 48 hours, or sometimes longer. Both methods provide detailed information about the frequency, duration, and timing of acid reflux episodes, helping to determine if symptoms are caused by acid reflux and how they relate to daily activities.
Other Diagnostic Tests
Esophageal manometry is another diagnostic test used to evaluate the function of the esophagus. This procedure measures the strength and coordination of muscle contractions in the esophagus and the pressure within the lower esophageal sphincter (LES), the muscle that prevents stomach contents from flowing back into the esophagus. It involves passing a thin tube with pressure sensors through the nose into the esophagus. Manometry is performed to rule out motility disorders that can mimic reflux symptoms or as part of a pre-surgical evaluation for anti-reflux procedures.
A barium swallow, also known as an upper GI series, is an imaging test that involves drinking a chalky liquid containing barium, which coats the lining of the upper digestive tract. X-ray images are then taken as the barium moves through the esophagus, stomach, and duodenum. This test can identify structural abnormalities such as strictures, hiatal hernias, or severe inflammation, providing a visual assessment of the anatomy and any changes caused by long-standing reflux.