Question: How is GERD (gastroesophageal reflux disease) diagnosed?
Answer: Patients with typical symptoms of GERD, such as heartburn and regurgitation, can be diagnosed with a visit to their physician and a quick history and physical examination. Patients with more severe disease or disease that is resistant to treatment with medications often require more invasive testing. The first line test is an upper endoscopy. This is a procedure in which a tube with a camera on the end is inserted through the mouth into the lower esophagus to visualize the lining of the esophagus.
Patients with bad reflux will have severe esophagitis which is an inflammation of this lining or can have evidence of long term complications such as a stricture or Barret's esophagus, in which the lining of the esophagus changes from one cell type to another. The gold standard for diagnosis of gastroesophageal reflux is with acid PH monitoring. These tests occur with either a wireless or catheter-based technique in which a patients 24 hour acid exposure is measured by placing a sensor in the distal esophagus.
The distal esophagus is the lower part of the esophagus where reflux is more likely to occur. Patients typically have a catheter placed and have this in place for 24 hours during which time they're advised to return to their normal everyday activities and diet. After completion of this testing, a physician will interpret the results in the office and give a patient a reading on whether the reflux is severe or whether medications may be enough.