Gastroesophageal Reflux Disease (GERD); Diagnosis.

Many people with gastroesophageal reflux disease (GERD) go undiagnosed for years because they didn't consider their symptoms serious or they were able to treat them with common over-the-counter medications. Although rarely life threatening, frequent heartburn and other GERD-related symptoms can cause significant limitations in daily life and may lead to more significant complications, such as erosive esophagitis and Barrett's esophagus. Early diagnosis is important, not only for symptom relief, but to prevent long-term complications.

Diagnosing GERD is usually based on symptoms. Often your health care professional will begin by providing you with a sample questionnaire such as the following:

For the following questions describe your symptoms as never, rarely, once or twice a week, frequently, more than once a day.

Have you experienced heartburn?

Do you experience heartburn more than twice a week?

Does heartburn interfere with normal activities or sleep?

Does your heartburn cause severe pain that makes you unable to perform normal activities or sleep?

Have you experienced difficult or painful swallowing?

Have you ever experienced persistent coughing?

Have you experienced hoarseness or scratchy throat?

Have you had trouble breathing or wheezing?

Have you ever had chest pain?

How often do you take an antacid or over-the-counter medication for your symptoms?

Next, your health care professional conducts a physical exam, evaluating your mouth, teeth and throat for signs of redness, swelling or dental erosions. A lung exam may also be performed to listen for wheezing or other abnormal breath sounds, and a heart and abdominal exam may be given to check for masses, tenderness, abnormal sounds or heartbeats or abnormal collections of fluids, and to evaluate the size of your liver.

Those with more persistent or severe symptoms may require other diagnostic tests, including:

Laboratory tests. While there is no lab test or blood marker specifically for GERD, some people require laboratory tests to rule out other causes for their symptoms, such as blood tests for anemia, liver function, kidney function or cardiac enzymes (used to check if there has been any damage to the heart).

Endoscopy. In this test, you receive a mild sedative, and a lighted flexible tube, an endoscope, is passed through your mouth into your esophagus and down into your stomach. This allows your health care practitioner to visually check for inflammation and ulcers of the esophagus and stomach and for other abnormalities such as bleeding, narrowing of the esophagus and scarring. Most people with heartburn have a normal endoscopy, but it is important to perform the test to look for more extensive damage to the esophagus. Endoscopy also allows your doctor to take biopsies (small samples of the lining of the esophagus). Endoscopic biopsies are the only reliable way to diagnose Barrett's esophagus, a complication of GERD.

Twenty-four-hour pH monitoring. During this test, a catheter (a very thin tube) is passed to the bottom of the esophagus to measure acid reflux over 24 hours as you go through your normal activities. Recently, wireless systems of measuring gastroesophageal reflux have become available. Instead of wearing a catheter for 24 hours, a small capsule is attached to the esophagus, and pH measurements are transmitted via radio waves to a pager-sized receiver on your belt. This system, called the Bravo esophageal pH test, allows prolonged (48 hour) monitoring. The capsule detaches within 7 to 10 days. Even though this system eliminates the discomfort of wearing the tubes in the nose, some people may notice the capsule and complain of problems swallowing or painful swallowing.

Another development in reflux monitoring is the use of combined impedance and pH testing, a catheter that allows the measurement of acid as well as nonacid reflux. There is some recent evidence that nonacid reflux may cause symptoms in people who don't respond to treatment. More studies are needed to figure the exact role of nonacid reflux.

Esophageal manometry testing. During this test, a special tube is passed into the esophagus to measure both the muscle function during swallowing and the function of the lower esophageal sphincter. This test is not adequate for diagnosing reflux but is recommended if you're having trouble swallowing.

Upper gastrointestinal x-ray series. During this test, you drink a liquid contrast solution. As you swallow the liquid, x-rays are taken. This test doesn't diagnose GERD, but it can diagnose a hiatal hernia, narrowing of the esophagus or tumors obstructing the esophagus.

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Keywords: gastroesophageal reflux disease, gerd, heartburn, symptoms