How Gastroesophageal Reflux Disease (GERD) Is Diagnosed

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When you have the telltale symptoms of heartburn and regurgitation, gastroesophageal reflux disease (GERD) can often be diagnosed with just a physical examination and a review of a detailed history of your symptoms. However, if you don't have these classic red flags, your symptoms aren't getting any better with treatment, or your doctor wants to check for potential complications, you may have testing such as an upper endoscopy, an ambulatory acid (pH) monitoring examination, esophageal manometry, or a barium swallow radiograph done.

Labs and Tests

If your doctor decides to do tests to confirm that you have GERD or to check for complications that may result from GERD, these are some of the tests that are routinely used. Depending on your circumstances and test results, you may have more than one.

Upper Endoscopy
Upper endoscopy is performed in a hospital or an outpatient facility. Beforehand, you will receive a sedative to keep you relaxed throughout the procedure. Your doctor will spray your throat to numb it and slide a thin, flexible plastic tube called an endoscope down your throat.

A tiny camera and light in the endoscope allow your doctor to see the surface of your esophagus and search for abnormalities. During the procedure, your doctor may also remove a small piece of tissue so that it can be tested for complications like Barrett's esophagus.

If you have had moderate to severe symptoms and this procedure reveals ​any injury to your esophagus, no other tests are usually needed to confirm GERD.

Ambulatory Acid (pH) Monitoring Examination
In this test, which is done at a hospital or outpatient center, your doctor puts a tiny tube through your nose or mouth into your esophagus that will stay there for 24 hours. The other end of the tube connects to a small monitor. While you go about your normal activities, when and how much acid comes up into your esophagus is measured and recorded.

An ambulatory acid monitor is useful when you have GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux. This test is considered the most accurate to detect acid reflux.

Another form of pH monitoring is done with a capsule placed in your esophagus instead of a tube. The capsule wirelessly transmits acid measurements to a receiver you wear on your waistband. You also keep track of your symptoms by pushing certain buttons on the receiver and keeping a diary of activities such as when you eat and when you lie down.

Esophageal Manometry
This test measures the contractions in your esophagus when you swallow. It can show if your GERD symptoms are due to your sphincter muscle being weak and identify other issues with your esophagus that might be causing your symptoms instead of GERD.

It's done by numbing your throat and then placing a thin tube through your nose into your stomach. The tube is then pulled into your esophagus as you swallow while a computer takes measurements and records the contractions your esophagus makes in different areas. This can be done in your doctor's office.

Imaging

Your doctor may want to look at your upper gastrointestinal (GI) tract, especially if he or she suspects that you have a hiatal hernia or an issue with your esophagus.

Barium Swallow Radiograph
This test is done at an outpatient center or a hospital and uses X-rays of your upper GI tract to help spot abnormalities, though it can't show GERD. During this test, you'll sit or stand in front of an x-ray machine and drink a thick, chalky barium solution as X-rays are taken so your doctor can see how the barium moves through your mouth and esophagus. You may also drink a thinner barium solution and/or swallow a barium pill while pictures are again taken.

After the test, you may feel bloated or nauseous, and you may have light-colored stools from the barium. Mild esophageal irritation will not appear on this test, although narrowing (strictures) of the esophagus, ulcers, and a hiatal hernia will.

Infants and Children

If your child is healthy and growing well, your doctor may make a reflux diagnosis based on a physical exam and your description of symptoms and feeding or eating history alone. However, tests may be ordered if your doctor suspects a more serious condition such as GERD.

In these cases, diagnostic tests can include:

  • Lab tests: This can consist of various blood and urine tests to identify or rule out possible causes of recurring vomiting and poor weight gain.
  • Esophageal pH monitoring: This test will measure the acidity in your child's esophagus.
  • Upper endoscopy: Your doctor may use this procedure to see if there's a narrowing (stricture) or inflammation (esophagitis) in the esophagus.

Diagnosing Teens

Your doctor may base a diagnosis of acid reflux on your teen's symptoms, a physical examination, and your teen's response to medical treatment. For example, if your teen's symptoms improve after treatment with proton pump inhibitors (PPIs), then it's probably GERD. If the symptoms do not improve, your doctor may order tests to determine if GERD is the cause of the reflux. These tests may include one or more of the following:

  • Barium swallow radiograph
  • Esophageal pH monitoring
  • Upper endoscopy

Sources:

Kahrilas PJ. Clinical Manifestations and Diagnosis of Gastroesophageal Reflux in Adults. UpToDate. Updated March 6, 2018.

Mayo Clinic Staff. Gastroesophageal Reflux Disease (GERD). Mayo Clinic. Updated March 9, 2018.

National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of GER and GERD. U.S. Department of Health and Human Services. Published November 2014.

Vandenplas Y, Hauser B. An Updated Review on Gastro-Esophageal Reflux in Pediatrics. Expert Review in Gastroenterology and Hepatology. 2015;9(12):1511-21. doi:10.1586/17474124.2015.1093932.