Heartburn/GERD Diagnosis

Most cases of GERD can be diagnosed and treated by primary care doctors. However some patients may require referral to gastroenterologists, the doctors who specialize in the diseases of the digestive system.

Many cases of GERD can be diagnosed on the basis of medical history and physical exam results. Your doctor will ask you a number of questions pertaining to the symptoms, such as their onset, frequency, and severity. It is also important for the doctor to find out what you do to relieve you from your symptoms and what seems to make them worse.

Physical examination is also an important diagnostic tool. During this procedure your doctor will:

• check your vital signs
• assess your heart and lung sounds
• examine your ears, nose, throat and teeth
• listen to your gastric sounds
• palpate your abdomen

Sometimes further testing may be needed to diagnose GERD and to find out the extent of damage it has caused. Below are the diagnostic tests for GERD:

Upper GI series or barium swallow is one of the common tests to diagnose problems in the esophagus, stomach, and duodenum. The stomach and small intestine must be empty for this procedure to be accurate. Before the scheduled upper GI series, the patient will be advised not to eat or drink anything after midnight. Other specific instructions will be given by the doctor.

For this test, the patient will be asked to drink barium, a thick, white, chalky liquid that will coat the digestive tract. Then X-rays of the upper digestive tract will be taken. The barium coating makes the esophagus, stomach and upper intestine to show up more clearly on X-ray. The upper GI series is useful in detecting problems such as ulcers, scar tissue, abnormal growths or hernia.

The upper GI series test usually takes 1 to 2 hours. It is a painless procedure, but the barium may cause constipation and white colored stool for a few days. The doctor may recommend drinking plenty of water to flush the barium from in about 2 to 3 days. Remedies for constipation may also be suggested.

Endoscopic examinationallows direct visualization of the esophagus and the stomach. In preparation for the procedure, the patient is advised not to eat anything for at least six hours before the scheduled endoscopy. A local anesthetic will be sprayed into the patient's throat to suppress the gag reflex, and a mild intravenous sedative will also be given to help the patient relax. Then a thin, flexible tube is inserted into the esophagus. The tube (endoscope) is equipped with a tiny camera and light, this device will give an accurate picture of what is happening in the upper gastrointestinal tract. The images from the esophagus and stomach will be seen on a video monitor. Still images can also be captured for for further diagnosis and hospital records. During endoscopy, the doctor also may collect tissue sample for further testing.

Ambulatory acid (pH) probe tests is currently the best method available for quantifying the exposure of the esophagus to acid. Ambulatory acid (pH) probe test records when, and for how long, stomach acid regurgitates into your esophagus. This test can also detect whether the reflux triggers respiratory symptoms, such as wheezing and coughing. In addition, the pH probe test can be used for evaluating the effectiveness of medical or surgical treatments.

In preparation for the ambulatory acid probe test, the patient will be instructed not eat or drink anything for six hours before the scheduled procedure. If you're taking GERD medications, your doctor may may also ask you to stop taking them to prepare for the test. Ambulatory acid (pH) probe tests involves placing an acid-measuring device in the esophagus. The doctor will first apply a local anesthetic to the nasal lining to numb the nose. Then a thin, flexible tube is passed through your nose into the esophagus. During the test, the tube stays in place and connects to a small computer that you wear around your waist or with a strap over your shoulder. After the probe is placed, the patient may leave the hospital and encouraged to continue normal activities. Resuming normal tasks will allow the doctor to get a realistic picture of what is happening in the esophagus. Patients will be asked to return in about 24 hours, the pH probe will be removed and the data will be transferred to a computer for analysis.

Esophageal impedance is a relatively new test for GERD. Impedance technology gives accurate information on the occurrence of reflux episode regardless of its chemical composition. Its basic principle is similar to the the 24-hour ambulatory acid testing: recording esophageal events with a probed placed through the nose. Unlike the pH probe, this test can detect episodes of low acid a or non-acid reflux, the height to which the regurgitation extends, and the clearing of the refluxed stomach contents from the esophagus. Impedance technology works by measuring changes in electrical current as substances pass through the esophagus.

Impedance monitoring is particularly helpful in assessing reflux in patients who are on acid suppression therapy. This group of patients may continue to have episodes of reflux even when their symptoms are controlled. In cases of adequate acid suppression, the reflux episodes may not be detected by the 24-hour acid probe test because the ph of the refluxed substance is not acidic enough.

http://health.usnews.com/usnews/health/digestive-diseases/gerd/gerd.test.impedance.htm

Fischer,J., Bland, K.I. Mastery of surgery, Volume 1. 2007. Wolters Kluwer Health/Lippincott Williams & Wilkins