Printer Friendly

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.

References

"Questions and Answers On Prilosec OTC (omeprazole)." U.S. Food and Drug Administration Center for Drug Evaluation and Research. http://www.fda.govUpdated 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.

"Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD)." The National Digestive Diseases Information Clearinghouse (A service of the National Institute of Diabetes and Digestive and Kidney Diseases, NIH). June 2003. http://digestive.niddk.nih.gov. Accessed August 2006.

"Gerd Treatment Center." Albert Einstein Health Network, 2006. http://www.einstein.edu. Accessed August 2006.

"The 48-Hour Bravo Esophageal pH Test." The Cleveland Clinic. February 2005. http://www.clevelandclinic.org. Accessed August 2006.

"GERD and Asthma." The Cleveland Clinic. January 2003. http://www.clevelandclinic.org. Accessed August 2006.

"Heartburn Common in Western Countries." The Lancet, via Merck Source Health News. June 2006. http://www.mercksource.com. Acceseed August 2006.

"Gastroesophageal Reflux Disease and Heartburn." Massachusetts General Hospital. http://www.mgh.harvard.edu. Accessed August 2006.

Keywords: gastroesophageal reflux disease, gerd, heartburn, symptoms
COPYRIGHT 2007 National Women's Health Resource Center
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:NWHRC Health Center - Gastroesophageal Reflux Disease
Geographic Code:1USA
Date:Mar 13, 2007
Words:1517
Previous Article:Gastroesophageal Reflux Disease (GERD); Gastroesophageal Reflux Disease (GERD).
Next Article:Gastroesophageal Reflux Disease (GERD); Treatment.
Topics:


Related Articles
MII-pH measure tags cause of recalcitrant reflux.
Gastroesophageal Reflux Disease (GERD); Diagnosis.
Gastroesophageal Reflux Disease (GERD); Facts to Know.
Gastroesophageal Reflux Disease (GERD); Questions to Ask.
Gastroesophageal Reflux Disease (GERD); Key Q&A.
Gastroesophageal Reflux Disease (GERD); Gastroesophageal Reflux Disease (GERD).
Gastroesophageal Reflux Disease (GERD); Gastroesophageal Reflux Disease (GERD).
Gastroesophageal Reflux Disease (GERD); Facts to Know.
Gastroesophageal Reflux Disease (GERD); Questions to Ask.
Gastroesophageal Reflux Disease (GERD); Key Q&A.

Terms of use | Privacy policy | Copyright © 2018 Farlex, Inc. | Feedback | For webmasters