Diagnosing Gastroesophageal Reflux Disease

What a Doctor May Prescribe

Courtesy XiXinXing (Getty Images)

Occasional heartburn is harmless. About 20% of all adults will have heartburn at least once a month. It's when the heartburn becomes chronic that it can mean that something more serious is going on.

If you suffer from chronic heartburn, you may also have ​Gastroesophageal reflux disease, or GERD. But how do you find out if you do have GERD?

Your doctor may be able to tell if you have GERD from the symptoms you have.

If your symptoms are fairly mild, your doctor may try treatment in an attempt to ease your symptoms. Over-the-counter antacids may bring relief from heartburn and acid reflux. If symptoms continue, a proton-pump inhibitor, a medication such as Prilosec (omeprazole) that blocks stomach acid secretion, can bring relief in the majority of patients with GERD.

Sometimes, however, laboratory or other tests may be required if your doctor is still uncertain of the diagnosis. Testing is also done if the doctor suspects complications, such as Barrett's esophagus, or if the patient experience such things as bleeding or difficulty in swallowing.

There are several tests that can be performed.

  • Barium X-rays
  • Endoscopic Examination
  • PH Monitor Examination
  • Manometry

Barium X-rays

Barium x-rays are diagnostic x-rays in which barium is used to diagnose abnormalities of the digestive tract. The patient drinks a liquid that contains barium, which will coat the walls of the esophagus and stomach. X-rays are then taken, which can then show if there are strictures, ulcers, hiatal hernias, erosions or other abnormalities.​​

What can be expected if the doctor orders barium x-rays?

These tests are usually done on an outpatient basis at the hospital, in the radiology department, and generally follow the process listed below.

  • The patient is asked not to eat or drink anything after midnight on the night before the exam.​
  • The patient stands against an upright x-ray table in front of a fluoroscope, a device that will immediately show a moving picture. The patient then drinks the barium liquid and swallow baking soda crystals. The radiologist can watch the barium flow through the digestive tract. The patient may be asked to move into different positions while the x-rays are taken so the doctor can observe the barium from different angles as it travels down the esophagus and into the stomach.​
  • Since barium may cause constipation, the patient is advised to drink plenty of fluids and eat high fiber foods for the next day or two until the barium passes from the body

Upper Endoscopy

The upper endoscopy (also known as esophagogastroduodenoscopy or EGD) allows the doctor to examine the inside of the patient's esophagus, stomach, and duodenum (the first part of the small intestine) with an instrument called an endoscope, a thin flexible lighted tube. The doctor will be able to see the walls and tissue of the upper digestive tract, and will be able to detect disorders such as strictures (narrowed areas), hiatal hernias, ulcers and tumors.

What can be expected if the doctor orders an EGD?

  • The patient is not to eat anything for at least six hours before the procedure.​
  • A local anesthetic will be sprayed into the patient's throat to suppress the gag reflex, and an intravenous sedative that will help the patient relax.​
  • The endoscope is then slowly passed into the patient's mouth and down the esophagus. The gag reflex and the urge to vomit usually pass once the tube is in the esophagus. The tube will not interfere with breathing.​
  • Once the endoscope is in place, the doctor will be able to examine the esophagus and stomach through a tiny camera, and detect any abnormalities. Other instruments can be inserted through the endoscope tube, which will allow the doctor to perform biopsies if such conditions as cancer or infections are evident.​
  • The patient may experience a sore throat for a few days after the procedure. This is common. If complications, such as vomiting a large amount of blood or severe stomach pains, occur, the doctor should be notified immediately.

    pH Monitoring

    This procedure is done with a thin, plastic tube with a sensor that measures the amount of acid backing up into the esophagus. This procedure is often done when GERD symptoms are present but an endoscope exam doesn't detect.​

    What can be expected if the doctor orders pH monitoring?

    • The doctor inserts a tubular probe through the nose and into the esophagus. The tube stops just above the lower esophageal sphincter (LES).​
    • The tube is left in place for 24 hours. The patient is encouraged to engage in normal activities.​
    • The patient keeps a record of any symptoms that are suspected to be acid reflux. The patient also will record other symptoms, such as coughing and wheezing. This can help the doctor determine if acid reflux is related to unexplained asthmatic or other respiratory symptoms.


    Manometry is a technique that records muscular pressure. A small tube is guided through the patient's nose and into the esophagus. A computer connected to the sensor on the tube will measure the muscular pressure in the esophagus and stomach.

    This test is useful for the following reasons:

    • Measurements of the pressure exerted by the lower esophageal sphincter (LES) muscles, and helps determine which patients need and would benefit from surgery.
    • It can detect muscle action abnormalities, such as impaired stomach motility (an inability of the stomach muscles to contract normally).
    • It can detect if impaired peristalsis or other motor abnormalities are causing the chest pain in patients who have GERD.

    Continue Reading