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Acid Reflux Test - Upper Endoscopy

This acid reflux test is for 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 can also be used in various surgical techniques.

Barrett's esophagus is diagnosed using endoscopy, a procedure that involves inserting a tube down the throat so that the physician can view the esophagus. Some experts recommend a one-time screening test for Barrett's esophagus using endoscopy in high-risk patients (such as obese men) with severe acid reflux.

Periodic endoscopy is recommended for detecting early cancer in patients who have been diagnosed with Barrett's esophagus. When Barrett's esophagus is diagnosed, multiple biopsies are generally taken. The biopsy results (show no dysplasia, low-grade dysplasia, or high-grade dysplasia) will determine the frequency of future monitoring.
Endoscopy may be performed either in a hospital or in a doctor's office:

How the Test is Done

  • The doctor administers a local anesthetic using an oral spray and an intravenous sedative to suppress the gag reflex and to relax the patient.
  • Next, the physician places an endoscope (a thin flexible plastic tube containing a tiny camera) into the patient's mouth and down the esophagus. The procedure does not interfere with breathing. It may be slightly uncomfortable for some patients; others are able to sleep through it.
  • Once the endoscope is in place, 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 performs a biopsy (the removal and microscopic examination of small tissue sections). The biopsy may detect tissue injury indicative of 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.

How to Prepare for the Test

You may be asked not to eat or drink before some types of endoscopy, such as an examination of the upper gastrointestinal tract. Before an examination of the lower gastrointestinal tract, you may also be asked to clear the colon of stool, using enemas or laxatives.

How the Test Will Feel

During an endoscopy, the patient is sedated (given a drug to help them relax and possibly sleep). With the right sedation, the patient should feel little if any discomfort.

Possible Risks and Complications from the Test

The major risks are pain, bleeding, or infection. For gastrointestinal endoscopy, there is also a risk of perforation (tearing) of the intestinal wall. Reactions to the anesthesia can occur (though they are rare). For this reason your breathing, blood pressure, heart rate, and oxygen level will be monitored during the procedure.

Complications from the procedure are uncommon. If they occur, complications are almost always mild and typically include minor bleeding from the biopsy site or irritation where medications were injected.

If a patient has moderate-to-severe GERD symptoms and the procedure reveals injury in the esophagus, usually no further tests are needed to confirm a diagnosis. The test is not foolproof, however. A visual view misses about half of all esophageal abnormalities.

Interpreting the Results

The examination should reveal normal function and appearance of the area being examined. For example, with gastrointestinal endoscopy, the lining of the gastrointestinal tract should be smooth, with no unusual growths or lesions. A wide variety of abnormal findings may occur, and the physician will review them following the exam.

Capsule Endoscopy

Capsule endoscopy was first approved for use in 2000. In this test, the patient swallows a small capsule containing a tiny camera. An esophagus-specific capsule device was approved in 2004. After the patient swallows the capsule, a series of color pictures are transmitted to a recording device where they can be downloaded and interpreted by a doctor. The entire procedure takes 20 minutes. The capsule is naturally passed through the digestive system within 24 hours. A newer technique has a string attached to the capsule for retrieval. Capsule endoscopy may provide a more attractive and less invasive alternative for patients than traditional endoscopy. However, while capsule endoscopy is useful as a screening device for diagnosing esophageal conditions such as GERD and Barrett's esophagus, traditional endoscopy is still required for gathering tissue samples or removing polyps.

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

Acid Reflux Test - Upper Endoscopy - References