Gastroesophageal reflux disease (GERD) occurs when the acid from the stomach backs up into the esophagus. To diagnose GERD, a medical professional may order one or more tests to measure acid levels and the functioning of the digestive system.
Food moves from the mouth, down the esophagus, and into the stomach. A sphincter between the esophagus and stomach prevents acid and stomach contents from traveling back up the esophagus. The sphincter is a ring of muscles that closes tightly after food passes through, sealing off the esophagus.
For people with GERD, the lower esophageal sphincter does not function properly and allows food and acid to move back into the esophagus. Doctors call this reflux.
To diagnose GERD, a medical professional will take a complete medical history and ask about symptoms.
Symptoms may be enough to diagnose GERD, but in many cases, the doctor will order one or more tests to examine the esophagus.
The most common tests performed are:
- upper endoscopy
- impedance-pH test
- Bravo pH monitoring
- esophageal manometry
- barium swallow
These tests allow a doctor to look at the structure of the digestive tract and the motion of food and acid. An upper endoscopy is often the first step.
Some doctors also choose to begin treatment immediately based on symptoms.
Doctors will perform some tests for GERD in their office or an outpatient clinic. Others require an individual to wear sensing equipment for 24–48 hours to measure acid levels and the motion of the digestive tract.
Doctors will perform an upper endoscopy under light anesthetic. It is the most common first step in diagnosing GERD.
After sedating the person, the doctor will insert an endoscope — a flexible tube — down the throat through the esophagus. The tube has a light and a camera which allow the doctor to see the structure of the esophagus, stomach, and small intestine and look for damage or problems.
If damage is visible in the esophagus, the doctor may use small instruments that pass through the endoscope to take a biopsy.
This exam takes place over a 24-hour period. It measures the levels of liquid and air that are passing through the esophagus into the stomach. This test can reveal whether GERD is acidic or nonacidic, which can determine the course of treatment.
At their office, a doctor will spray a topical anesthetic into the throat to numb the area. They will then place a thin, flexible catheter through the nose and into the esophagus and stomach.
The catheter affixes to the nose with tape, wraps behind an ear, and connects to a small reader that the person wears on the waist when they return home.
The reader will log measurements of acid moving from the stomach into the esophagus over the next 24 hours. Additionally, the person will keep a written record of symptoms during the time they wear the catheter. The catheter is generally not uncomfortable and does not interfere with eating or sleeping.
When the person returns, the doctor will remove the catheter and collect the reader and the written record. They will then examine the results to determine when episodes of reflux occurred and whether they were acidic or nonacidic.
Bravo pH monitoring
This monitoring system is worn for 48–96 hours and allows a doctor to view the pH levels in the esophagus.
The doctor will spray numbing anesthetic into the back of the person’s throat. They then place a small capsule into the throat and attach it to the esophagus. The capsule wirelessly transmits readings to a device worn on the waist.
The capsule is able to read pH levels in the esophagus, measuring the presence of acid. The person will keep a written record of symptoms during the test.
The capsule is generally not uncomfortable and the person is able to proceed with normal activity.
After 48–96 hours, the doctor will collect the reader device and the written record. The capsule will naturally detach and pass through the digestive system to exit the body.
By comparing the written record of symptoms to the readings from the capsule, the doctor can measure how much acid is refluxing into the esophagus.
This test measures the motion of the muscles that control the digestive system and how well food passes through it. It measures pressure in the esophagus and can indicate if there is a structural problem that is causing reflux.
For this test, a doctor will place a catheter through the nose and into the esophagus. The catheter contains sensors that measure pressure and movement. Over the course of 10–15 minutes, the doctor will view the readings from the catheter on a computer and determine a course of treatment.
Barium swallow test
Barium is a special liquid dye that shows up on an X-ray. For this test, a person will drink barium, which will coat the digestive tract. Barium is a thick, chalky liquid that may have an artificial flavor in order to make it easier to swallow.
The barium coating the esophagus, stomach, and intestines will show up on an X-ray. This test can reveal the presence of a hiatal hernia, ulcers in the esophagus, or stricture (narrowing) of the esophagus.
Doctors often use barium swallow tests in conjunction with other tests to diagnose and measure the severity of GERD.
These tests will measure the presence of GERD, its severity, and how much damage exists in the esophagus.
They will also reveal whether GERD is the result of a structural problem in the esophagus or stomach, a hiatal hernia, problems with digestive tract motion, overproduction of acid, or other factors.
Without treatment, GERD can cause long-term damage to the esophagus and result in Barrett’s esophagus, a condition where different tissue similar to that which lines the intestine replaces the usual lining of the esophagus. Precancerous cells can then form in this new esophageal lining.
Treatment depends on the cause of GERD, how much damage is in the digestive tract, and lifestyle considerations.
In addition to medication or surgical treatment options, the doctor may advise the individual to:
- elevate the head of their bed
- lose any excess weight
- stop smoking
- reduce alcohol consumption
- eat smaller meal sizes
- reduce caffeine consumption
- avoid certain medications
When GERD exists, the doctor
Medications that treat GERD include antacids, H2 blockers, and proton pump inhibitors (PPIs). Antacids relieve symptoms and doctors intend them for the treatment of occasional episodes of GERD. H2 blockers and PPIs reduce the production of acid from the stomach. PPIs can also help to heal the lining of the esophagus.
Surgery is an option for GERD, but doctors will generally only recommend this after habit changes and medication have proved unsuccessful. Surgery can better attach the top of the stomach to the lower esophageal sphincter to help reduce reflux.
Doctors may also recommend bariatric surgery to lose weight for individuals who are overweight.
Without treatment, GERD can cause a condition called Barrett’s esophagus. This is when precancerous cells form in the esophagus.
People generally tolerate GERD treatments well, and the condition responds well to habit changes and medications. Treatment may be long-term.
GERD is a condition that occurs when stomach contents and acid back up into the esophagus. It produces a burning sensation and is also known as acid reflux.
A doctor may order several tests to diagnose GERD. They may perform them in-office or require the individual to wear a measuring device for 24–96 hours. The doctor may perform more than one test to diagnose GERD or begin treatment solely on the basis of symptoms.
Treatment for GERD includes habit changes, medications, and sometimes surgery. It is generally a condition that people are able to manage well when they are consistent with treatment.