Diagnosis of GERD

ph_monitoring_capsuleGERD is usually diagnosed based on the typical symptoms. However, some people that suffer from GERD don’t experience any clear symptoms; thus, the need for special methods arises. Also, additional methods are used to monitor the progress of the therapy.

Currently, the golden standard of GERD diagnosis is esophageal pH monitoring.

Esophageal pH monitoring - allows to easily detect reflux disease, assess its severity and monitor the patients’ response to the medical treatment. This method can be carried out with a single or dual sensor for pH monitoring using a pH catheter, or by using a Bravo or OMOM pH monitoring capsules which allow for wireless pH monitoring.

Other methods include

  • Esophagogastroduodenoscopy (EGD) – during this method the doctor inserts a tube into the patient’s mouth. This tube contains a camera, which allows the doctor to view the interior of the patient’s esophagus, stomach, and small intestine. This device can also take tissue samples from the walls. EGD allows the gastroenterologist to evaluate the damage to the esophagus, though it’s less commonly used to evaluate the success of the treatment.
  • Barium swallow X-rays while the patient is lying down – during this procedure the patient swallows a barium sulfate suspension (which is opaque to X-rays), which coats the esophagus with a thin layer of barium, enabling it to be viewed on X-rays. Horizontal position of the patient allows for the higher amount of barium to be present in the esophagus. Baking soda (sodium bicarbonate) is often used in combination with this method to fill the esophagus with air, thus, creating a double contrast, which allows for a better visualization of the mucosal layer of the esophagus and any changes to its structure.
  • Proton-pump inhibitor test (earlier known as omeprazole test) – involves administering a proton-pump inhibitor (usually omeprazole or rabeprazole) to the patient to see if the symptoms (which are thought to be the manifestation of GERD) will disappear. If the symptoms disappear, then the diagnosis is verified. Rabeprozole is more suitable for this purpose than omeprazole, since the former acts quicker than any other proton-pump inhibitor. Studies have shown that this test is at least as sensitive as the ambulatory 24 hour esophageal pH monitoring for diagnosing GERD.
  • Esophageal manometry – is not used as a diagnostic tool, but is recommended prior to surgery. This method is carried out using a catheter to evaluate the motor function of the upper and lower esophageal sphincters, and the esophageal body.
  • Test for biliary reflux – this test is sensitive to alkaline substances and is used to diagnose a condition during which biliary fluid flows back into stomach and then the esophagus.
  • Esophageal scintigraphy – allows diagnosing GERD by providing a quantitative date on esophageal transit, while exposing the patient only to small doses of radiation. The main advantage of this technique is that it is not invasive.
  • Bernstein test (also known as acid perfusion test) – is used to determine whether the substernal pain is caused by reflux esophagitis. It is performed by instilling a weak hydrochloric acid solution directly into the distal part of the esophagus. The pain disappears when the acidic solution is replaced with normal saline solution.