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Gastroesophageal Reflux Disease (GERD); Diagnosis.

Many people with gastroesophageal reflux disease (GERD) go undiagnosed for years because they did not 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 esophagitis and Barrett's esophagus (see the "Overview" section of this topic at this Web site for definitions of these conditions). Early diagnosis is important, not only for symptom relief, but for the prevention of long-term complications.

The diagnosis of GERD for many people is based simply on symptoms alone. Often your physician or 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?

The next step, the physical exam, allows the examiner to evaluate your mouth, teeth, throat for signs of redness, swelling or dental erosions. A lung exam will be preformed to listen for wheezing or other abnormal breath sounds. He or she will then conduct a heart and abdominal exam to check for masses, tenderness, abnormal sounds or heartbeats, abnormal collections of fluids, and to evaluate your liver size.

For most patients, this is all that is needed for a diagnosis of GERD. For those patients with more persistent or severe symptoms other diagnostics tests may be required to diagnose GERD or other conditions that present with similar symptoms.

Laboratory tests

There is no lab test or blood marker specifically for GERD, but some patients may require laboratory tests to rule out other causes of their symptoms. These might include blood tests for anemia, liver function, kidney function or cardiac enzymes (used to check if there has been any damage to the heart).


The patient is given a mild sedative and a lighted flexible tube, an endoscope, is passed through the mouth into the esophagus and down into the stomach. This allows the examiner to visually check for inflammation and ulcers of the esophagus and stomach, and also for other abnormalities such as bleeding, narrowing of the esophagus and scarring. Biopsies of tissue may also be taken. Endoscopic biopsies are the only way to diagnose Barrett's esophagus, which is a complication of GERD. Complications from this test are rare with less than one percent of those undergoing endoscopy having a major complication (perforation of the esophagus, hemorrhaging or aspiration). Other complications include minor tears in the esophagus, irregular heart rhythms, a medication reaction or low blood pressure.

Esophageal Manometry Testing

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 recommended in patients complaining of difficulties swallowing (dysphagia) or if symptoms do not improve with drug treatment. Rare complications include nose bleed, sore throat, perforation of the esophagus and aspiration pneumonia.

24-hour pH Monitoring

A very thin tube is passed to the bottom of the esophagus to measure acid reflux over 24 hours as the patient goes through his or her normal activities including eating and sleeping. Complications are the same as for manometry. 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 distal esophagus and pH measurements are transmitted via radio-waves to a pager-sized receiver worn at the belt. These systems allow prolonged (2 to 5 days) of monitoring. The capsule detaches itself within 7 to 10 days. Even though this system eliminates the discomfort of wearing the tubes in the nose, some patients may notice the capsule and complain of swallowing difficulties or painful swallowing.

Upper Gastrointestinal X-Ray Series

Patient drinks a liquid contrast solution. As the liquid is swallowed, x-rays are taken. This does not diagnose GERD, but it can diagnose a hiatal hernia, narrowing of the esophagus or tumors obstructing the esophagus. The most common complication is constipation, but on rare occasions perforation of the esophagus has occurred as well as aspiration.

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Editorial Staff of the National Women's Health Resource Center 2002/12/01 2005/03/16 Gastroesophageal reflux disease (GERD) is the abnormal backflow of stomach acid up into the esophagus, the long, muscular tube that connects the back of the mouth to the stomach. Acid Laryngitis,acid regurgitation,Barrett's esophagus,Esophageal strictures,Esophagitis,Gastroesophageal reflux disease,GERD,Reflux dyspareunia
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Publication:NWHRC Health Center - Gastroesophageal Reflux Disease
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Date:Mar 16, 2005
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