Diagnosing Acid Reflux Disease

Many people experience the pain of heartburn once in a while. However, some people have heartburn very frequently and may actually be suffering from GERD, an acid reflux disease. GERD can lead to serious complications if left untreated, including esophageal cancer.

What are the symptoms of acid reflux disease?

  • Pain when swallowing
  • Bad breath or a bad taste in the mouth caused by stomach acid
  • “Wet” burping
  • Heartburn or chest pain
  • Hoarseness or sore throat
  • Regurgitation

People who are diagnosed with acid reflux disease generally display one or more of these symptoms at least two times per week.

The most common symptoms of GERD are frequent heartburn and regurgitation. If you aren’t experiencing any other complications, your doctor may choose to diagnose and treat your acid reflux without further testing. In these cases, your doctor may recommend over-the-counter antacids or prescribe proton pump inhibitors, a medication that helps reduce the production of stomach acids.

If medication and diet changes don’t reduce the severity or frequency of your symptoms, your doctor may recommend further testing to diagnose any damage caused by acid reflux disease. Further testing may also be needed if you’re complaining of unusual weight loss, difficulty swallowing, anemia, or black stools.

There are several tests available to more accurately diagnose acid reflux disease and resulting complications. Your doctor may recommend a barium swallow radiograph, endoscopy or EGD, biopsy, esophageal manometry, esophageal impedance monitoring, or pH monitoring.

GERD Diagnosis

If you have frequent heartburn that doesn’t respond to medication, your doctor may recommend additional testing to diagnose acid reflux disease. Acid reflux disease can be diagnosed through a variety of different tests.

Barium Swallow Radiograph

In this test, you will swallow a solution of barium and then have your throat and upper chest X-rayed. The barium allows your doctor to see any structural problems in your esophagus more clearly. It should be completely painless.

Unfortunately, only about a third of GERD patients have esophageal changes that are visible on an X-ray.

Endoscopy or EGD

Unlike a barium swallow radiograph, the endoscopy actually allows the doctor to see the lining of the esophagus and stomach. This test is performed by putting a small tube with a camera on the end into your mouth and down into your esophagus. An endoscopy usually lasts about 20 minutes and is not typically painful. Your doctor may give you a mild sedative before the procedure to help your relax or spray your throat with an analgesic spray.

While an endoscopy will allow your doctor to see the lining of your stomach and esophagus, not all GERD patients have visible damage. It is possible to be diagnosed with acid reflux disease even if your endoscopy test doesn’t reveal any injury to your stomach or esophageal lining.


If an endoscopy shows esophageal damage, your doctor may do a biopsy. A biopsy involves removing a small piece of the esophageal lining, which will be tested later by a pathologist. Biopsies are commonly used to diagnose cancer or other underlying diseases.

Esophageal Manometry

An esophageal manometry is used to test the function of the esophagus and the esophageal sphincter, the valve between the stomach and esophagus that is supposed to prevent stomach acid from splashing back up into the esophagus.

Your doctor will apply a numbing agent to the inside of your nose and then insert a tube through your nose, down your esophagus, and into your stomach. Once the tube has been inserted, you will need to lay on your left side. Sensors on the tube will then measure the pressure on various parts of your esophagus and stomach. You may also be asked to swallow water while the tube is inserted to test how your muscles respond to swallowing.

An esophageal manometry usually takes 20 to 30 minutes to administer.

Esophageal Impedance Monitoring

Esophageal impedance monitoring may be done in conjunction with the esophageal manometry. If this is the case, the manometry tube will have electrodes on it to measure the rate of liquids and gases passing through your esophagus. The results of this test combined with the esophageal manometry will tell your doctor how effectively your body is moving substances into your stomach.

pH Monitoring

This is a test that monitors the acidity in your esophagus over a 24-hour period. It is performed by either inserting a tube through your nose that is connected to a small monitoring device, or by attaching a sensor to your lower esophagus using suction. The wireless probe is generally thought to be more comfortable for the patient.

In both versions of the test, you will keep track of what you eat during the 24-hour test period. You will also push a button on the monitor whenever you experience acid reflux symptoms. Your doctor will later be able to analyze the recorded results.

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