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Acid Reflux Diagnosis

If you suffer from frequent heartburn, chances are you have acid reflux (occasional heartburn does not necessarily mean you have acid reflux disease). Your doctor can usually make an acid reflux diagnosis if you find no relief from persistent heartburn and acid reflux after taking antacids.

If the acid reflux diagnosis is uncertain but acid reflux disease is still suspected, a drug trial using a proton-pump inhibitor medication (a drug that blocks stomach acid secretion), such as Prilosec identifies over 80% of people with the conditions.

Laboratory or more invasive tests, including endoscopy, may be required in the following cases:

  • If the diagnosis is still uncertain
  • If atypical symptoms are present
  • If Barrett's esophagus is suspected
  • If complications, such as signs of bleeding or difficulty in swallowing, are present

These tests may include:

Upper endoscopy

Upper endoscopy, also called esophagogastroduodenoscopy or panendoscopy, is widely used in acid reflux diagnosis, for purposes that include identifying and grading severe esophagitis, periodic monitoring of patients with Barrett's esophagus, screening people at high risk for BE, or when other complications of GERD are suspected. Upper endoscopy is also used as part of various surgical techniques.

An endoscope is a thin flexible plastic tube containing a tiny camera. It is inserted into the patient's mouth and down the esophagus. The camera allows the physician to see the surface of the esophagus and to look for abnormalities, including hiatal hernia and damage to the mucous lining. The physician may perform a biopsy (the removal and microscopic examination of small tissue sections). The biopsy can detect tissue injury indicating GERD. It may also be used to detect cancer or other conditions, such as yeast (Candida albicans) or viral infections (such as herpes simplex and cytomegalovirus). Such infections are more likely to occur in people with impaired immune systems.

For more details and video see Acid Reflux Test - Upper Endoscopy

Manometry

Manometry is a technique for acid reflux diagnosis that measures muscular pressure. A tube containing various openings is run through the esophagus. As the muscular action of the esophagus exerts pressure on the tube in various locations, a computer connected to the tube measures this pressure. Manometry is useful in determining if a patient has impaired peristalsis or other motor abnormalities that are causing chest pain or heartburn symptoms.

For more details and video see Acid Reflux Test - Esophageal Manometry

pH Monitoring

Esophageal pH monitoring is a test that measures how often and for how long stomach acid enters the esophagus.

For more details and video see Acid Reflux Test - Esophageal pH Monitoring

Barium swallow radiograph

A barium swallow radiograph (x-ray) is useful for identifying structural abnormalities and erosive esophagitis. For this test, the patient drinks a solution containing barium, and then x-rays of the digestive tract are taken. This test can show stricture, active ulcer craters, hiatal hernia, erosion, or other abnormalities. The test cannot reveal mild irritation.

For more details and video see Acid Reflux Test - Barium swallow x-rays

Less common tests

Blood and stool tests may show traces of blood that are not visible without a microscope.

For more details and video see Acid Reflux Test - Fecal Occult Blood Test

For patients with chest pain in which an acid reflux diagnosis is uncertain, a procedure called the Bernstein test may be implemented. A tube is inserted through the patient's nasal passage. Solutions of hydrochloric acid and saline are administered separately into the esophagus. A diagnosis of GERD is established if the acid infusion causes symptoms and the saline solution does not. For more details see Acid Reflux Test - The Bernstein Test

Similar disorders

Because many illnesses share similar symptoms, careful analysis and consideration of the patient is essential for an accurate diagnosis. The following conditons could accompany or resemble acid reflux disease:

Dyspepsia is most commonly confused with GERD. Dyspepsia is pain or discomfort in the upper abdomen without heartburn. Specific symptoms may include a feeling of fullness, bloating, and nausea. Dyspepsia can be a symptom of GERD, but does not always occur with GERD. The drug metoclopramide (Reglan) helps stomach emptying and may be helpful for this condition.

Angina and Chest Pain. About 600,000 people come to emergency rooms each year with chest pains. More than 100,000 of these people are believed to actually have GERD. Chest pain from both GERD and severe angina can occur after a heavy meal. In general, a heart problem is probably not responsible for the pain if it is worse at night and does not occur after exercise. It should be noted that the two conditions often coexist. In fact, there is some theory that in patients with coronary artery disease, acid reflux may actually trigger angina. In such cases, experts believe that acid in the esophagus may activate nerves that temporarily impair blood flow to the heart.

Other gastrointestinal diseases such as inflammatory bowel disease, ulcers, and intestinal cancers can cause acid refluxing to occur and should be considered in making an acid reflux diagnosis.

By Mortin - Copyright 2009
Last modification 31/12/2009

Acid Reflux Diagnosis - References