digestive disorders
Gastroesophageal Reflux Disease (GERD)
Diagnosis of GERD
Endoscopy with biopsy Sometimes pH testing Sometimes manometry When symptoms point to the diagnosis of GERD, treatment can be started without testing. Testing is usually reserved for situations in which the diagnosis is not clear, treatment has not controlled symptoms, or symptoms have been present for a long time. When testing is needed, the first test is usually to examine the esophagus using a flexible viewing tube ( Endoscopy ). Endoscopy is the best test for diagnosing esophagitis, erosive esophagitis, esophageal ulcer, esophageal strictures, esophageal cancer, and Barrett esophagus. During endoscopy, doctors may remove tissue for examination under a microscope (biopsy). If endoscopy and biopsy results are normal in people whose symptoms are very suggestive of GERD, doctors may do esophageal pH testing (pH is a measure of acidity—see Catheter-Based Monitoring ). In this test, a thin, flexible tube with a sensor probe on the tip is placed through the nose and into the lower esophagus. The tube stays in place for 24 hours. The other end of this tube is attached to a monitor that is worn by the person. The monitor records the acid levels in the esophagus, usually for 24 hours. Besides determining how much reflux is occurring, this test identifies the relationship between symptoms and reflux. This test is also helpful for people who have symptoms that are not typical of reflux. The esophageal pH test is suggested for all people being considered for surgery to correct gastroesophageal reflux. People who cannot tolerate a tube in their nose can have a small pH capsule attached to the lower part of their esophagus (see Pressure measurements at the lower esophageal sphincter using a test called Manometry indicate how well the sphincter is functioning and also provide information on the strength with which the esophageal muscles push. The information gained from this test helps the doctor decide whether surgery is an appropriate treatment. 