Generally, a diagnosis of GERD is done symptomatically.
However, the following tests are carried out to confirm GERD:
Physical Examination of throat and larynx:
Symptoms of cough, hoarseness or sore throat are observed in patients
suffering from GERD. Signs of inflammation of larynx and throat may indicate
This type of diagnostic testing was carried out before the introduction
of endoscopy. Permanent pictures (X-ray films) of the esophagus
(esophagogram) were taken by advising the patient to swallow barium
(contrast material) and the pictures taken with the patient lying
in different positions tracing the movement of contrasting material
through esophagus. Thus, ulcers and strictures were detected by
this method (2).
In upper gastrointestinal endoscopy, or Esophago-Gastro-Duodenoscopy
(EGD), an optical system for visualization is swallowed and the
lining of esophagus, stomach and duodenum examined as it progresses
down the gastrointestinal tract (GI tract). Inflamed lining of
esophagus (Esophagitis), ulcers, possible cancers, and complications
due to GERD such as strictures and Barretts esophagus are
diagnosed with the help of endoscopy.
Persistent/severe GERD causes changes in cells lining
the esophagus turning them initially into precancerous cells and later
cancerous, this condition is called Barretts esophagus (2).
Esophageal Acid Testing:
This testing is called gold standard for diagnosing GERD.
The quantity of acid in an individual suffering from GERD is compared
to a normal person's level of acid. The Esophagus contains acid most
of the time in patients of GERD; this can be determined by a test called
the 24-hour esophageal ph test. A small tube called a catheter, with
an acid sensor at its tip, is inserted through the nose and positioned
in the esophagus. The other end travels down to the waist after exiting
from the nose and then attaching to a recorder. The recorder records
every reflux episode in the esophagus and a 24 hour frame of data is
Another method used for prolonged
measurement of 48 hours is with the help of a small,
wireless capsule, which is attached to the esophagus just
above the Lower Esophageal Sphincter (LES) by passing it
through the mouth or nose with the help of a tube. The
acid refluxes are measured by the capsule and transmitted
to a receiver worn at the waist. The recordings from the
receiver are downloaded into a computer and analyzed. The
capsule fall of the esophagus after about 3-5 days and
passes out through stool, it is not reusable (2).
Esophageal Motility Testing:
Motility testing of the esophagus determines the working
of muscles of the esophagus by passing a catheter through
a nostril down the throat into the esophagus. The
catheter contains a sensor to detect pressure inside the
esophagus and the other end is attached to a recorder.
The patient is then permitted to swallow sips of water to
record and evaluate the esophageal contraction movements.
Motility disorders can be rectified sometimes through a
Acid Perfusion Test or Bernstein Test:
This test is used to determine if the chest pain caused is due to acid
reflux. A dilute acid solution and a physiologic salt solution are poured
into the catheter that is passed through the nostril of the patient into
the middle of the esophagus. If the patient experiences pain on pouring
the acid solution and if the patient does not experience on perfusion
of salt solution, it is implied that the pain is caused due to acid reflux
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