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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).

Endoscopy

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.

"Questions and Answers On Prilosec OTC (omeprazole)." U.S. Food and Drug Administration Center for Drug Evaluation and Research. http://www.fda.gov Updated July 16, 2003; Accessed September 16, 2003.

Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825-31.

Locke GR III, Talley NJ, Fett SR, Zinsmeister AR, Melton LJ III. Prevalence and clinical spectrum of gastroesophageal reflux: A population based study in Olmsted County, Minnesota. Gastroenterology 1997; 112:1448-56.

Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: Incidence and precipitating factors. Dig Dis Sci 1976;21:953-6.

Thompson WG, Heaton KW. Heartburn and globus in apparently healthy people. Can Med Ass J 1982;126:46-8.

Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ III. Dyspepsia and dyspepsia subgroups: A population-based study. Gastroenterology 1992;102:1259-68.

Isolauri J, Laippala P. Prevalence of symptoms suggestive of gastroesophageal reflux in an adult population. Ann Med 1995;27:67-70.

"Learning to Live with Chronic Heartburn" MayoClinic.com, http://www.mayoclinic.com. Accessed July 22, 2002.

"What is Heartburn?" MayoClinic.com, http://www.mayoclinic.com. Accessed July 22, 2002.

Spechler, S.J., and et al. "Long-term Outcome of Medical and Surgical Therapies for Gastroesophageal Reflux Disease: Follow-up of a Randomized Controlled Trial." JAMA, May 9, 2001, Vol. 285. http://jama.ama-assn.org. Accessed July 22, 2002.

Spechler, S.J. "Epidemiology and natural history of gastro-oesophageal reflux disease." Digestion, 1992, Vol. 51 Suppl 1, p. 24-29.

Scott, M. and Gelhot, A.R. "Gastroesophageal reflux disease: diagnosis and management." American Family Physician, March, 1999, http://www.aafp.org. Accessed Aug. 20, 2002.

"Gastroesophageal Reflux Disease." JAMA, May 9, 2001, Vol. 285, No. 18, p. 2408.

"About GERD." About GERD, http://www.aboutgerd.org. Accessed July 22, 2002.

Palmer, J. "Living with GERD." About GERD, http://www.aboutgerd.org. Accessed July 22, 2002.

Thompson, W.G. "What Else can we Attribute to GERD?" About GERD, http://www.aboutgerd.org. Accessed July 22, 2002.

Waring, J.P. "Questions and Answers about Medications and GERD." About GERD, http://www.aboutgerd.org. Accessed July 22, 2002.

"Smoking and Your Digestive System." About GERD, http://www.aboutgerd.org. Accessed July 22, 2002.

"Heartburn, Hiatal Hernia and Gastroesophageal Reflux Disease." The National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases, http://www.niddk.nih.gov. Accessed July 22, 2002.

"Barrett's Esophagus." The National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases, http://www.niddk.nih.gov. Accessed July 22, 2002.

"Heartburn." The American Gastroenterological Association, http://www.gastro.org. Accessed July 22, 2002.

Falk, J.L. and O'Brien, J.F. "Chest Pain," chapter 24, Emergency Medicine: A Comprehensive Study Guide, American College of Emergency Physicians, McGrall-Hill, New York, 4th Edition, 1996. P.193.

Silverthorn, D.U. "Digestion." Chapter 20, Human Physiology: An Integrated Approach, Prentice Hall, Upper Saddle River, NJ, 2nd Ed. 2001. P. 602-633.

Gilbert DA, et al: (supplement). "National ASGE Survey on upper gastrointestinal bleeding - complications of endoscopy." Digestive Diseases and Sciences, 1981; Vol. 26 (7), p. 55-59

"GERD & Pregnancy." The Cleveland Clinic Health Information Home. http://www.cchs.net. Accessed Aug. 26, 2002.

Field SK, and et al. "Prevalence of gastroesophageal reflux symptoms in asthma." Chest 1996; Vol. 109, p. 316-322.

Field SK and Sutherland LR. "Does medical antireflux therapy improve asthma in asthmatics with gastroesophageal reflux? A critical review of the literature." Chest 1998, Vol. 114, p. 275-283.

"H. pylori and peptic ulcers." The National Digestive Diseases Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases. http://www.niddk.nih.gov. Accessed Aug. 26, 2002.

Richter JE. "Extraesophageal presentations of gastroesophageal reflux disease." Seminars in Gastrointestinal Disease, April 1997, Vol.8(2), p. 75-89.

DeVault KR, et al. "Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease." The American Journal of Gastroenterology, 1999, Vol. 94(6), p. 1434-1442.

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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