Gastro-oesophageal reflux disease

Diagnosing gastro-oesophageal reflux disease

In most cases, your GP will be able to diagnose gastro-oesophageal reflux disease (GORD) by asking questions about your symptoms.

Further testing for GORD is usually only required if:

  • you have dysphagia (difficulty swallowing)
  • your symptoms do not improve despite taking medication

Further testing aims to confirm or disprove the diagnosis of GORD while checking for any other possible causes of your symptoms, such as irritiable bowel syndrome.

Endoscopy

An endoscopy is a procedure where the inside of your body is directly examined using an endoscope.

An endoscope is a long, thin flexible tube that has a light source and video camera at one end so that images of the inside of your body can be sent to an external monitor.

To confirm a diagnosis of GORD, the endoscope will be inserted into your mouth and down your throat. The procedure is usually done while you are awake, and you may be given a sedative to help you to relax.

An endoscopy is used to check whether the surface of your oesophagus has been damaged by stomach acid. It can also rule out more serious conditions that can also cause heartburn, such as stomach cancer.

Manometry

If an endoscopy does not find any evidence of damage to your oesophagus, you may be referred for a further test called manometry.

Manometry is used to assess how well your lower oesophageal sphincter (LOS) is working by measuring pressure levels inside the sphincter muscle.

During manometry, one of your nostrils will be numbed using a topical anaesthetic. A small tube will then be passed down your nostril and into your oesophagus to the site of the LOS. The tube contains a number of pressure sensors, which can detect the pressure generated by the muscle, then send the reading to a computer.

During the test, you will be asked to swallow some food and liquid to check how effectively your LOS is functioning.

A manometry test takes around 20 to 30 minutes to complete. It is not painful, but you may have minor side effects including:

However, these side effects should pass quickly once the test has been completed.

Manometry can be useful for confirming a diagnosis of GORD, or for detecting less common conditions that can disrupt the normal workings of the LOS, such as muscle spasms or achalasia (a rare swallowing disorder).

Barium swallow

If you are experiencing symptoms of dysphagia then you may be referred for a test known as a barium swallow.

The barium swallow test is one of the most effective ways of assessing your swallowing ability and finding exactly where the problems are occurring. The test can often identify blockages or problems with the muscles used during swallowing.

As part of the test, you will be asked to drink some barium solution. Barium is a non-toxic chemical that is widely used in tests because it shows up clearly on an X-ray. Once the barium moves down into your upper digestive system, a series of X-rays will be taken to identify any problems.

If you need to have a barium meal X-ray, you will not be able to eat or drink anything for at least six hours before the procedure so that your stomach and duodenum (top of the small intestine) are empty. You may be given an injection to relax the muscles in your digestive system.

You will then lie down on a couch and your specialist will give you a white, chalky liquid to drink which contains barium. As the barium fills your stomach, your specialist will be able to see your stomach on an X-ray monitor, as well as any ulcers or abnormal growths. Your couch may be tipped slightly during the test so that the barium fills all the areas of your stomach.

A barium swallow usually takes about 15 minutes to perform. Afterwards you will be able to eat and drink as normal, although you may need to drink more water to help flush the barium out of your system. You may feel slightly sick after a barium meal X-ray, and the barium may cause constipation. Your stools may also be white for a few days afterwards as the barium passes through your system.

24-hour pH monitoring

If the manometry test cannot find problems with your oesophageal sphincter muscles, another test known as 24-hour pH monitoring can be used (pH is a unit of measurement used in chemistry, and describes how acidic a solution is). The lower the pH level, the more acidic the solution is.

The 24-hour pH monitoring test is designed to measure pH levels around your oesophagus. You should stop taking medication used to treat GORD for seven days before having a 24-hour pH test because the medication could distort the test results.

During the test, a small tube containing a probe will be passed through your nose to the back of your oesophagus. This is not painful but can feel a little uncomfortable.

The probe is connected to a portable recording device about the size of an MP3 player, which you wear around your wrist. Throughout the 24-hour test period, you will be asked to press a button on the recorder every time you become aware of your symptoms.

You will be asked to complete a diary sheet by recording when you have symptoms upon eating. Eat as you normally would to ensure an accurate assessment can be made.

After the 24-hour period is over, the probe will be removed so measurements on the recorder can be analysed. If test results indicate a sudden rise in your pH levels after eating, a confident diagnosis of GORD can usually be made.

Last updated: 22 October 2012

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