“How is GERD diagnosed?”
I am experiencing a lot of heartburn along with some nausea and loss of appetite. Are these symptoms of GERD? What are the tests to confirm GERD in a person?
5 Answers
GERD is usually diagnosed by EGD (upper endoscopy). In the old days before EGDs, a barium swallow was used to demonstrate GERD.
Depending on the age group, most of the time is presumed based on symptoms. By symptoms only, we are accurate in the diagnosis around 50% of the time. In general the best way to make the diagnosis is with an upper endoscopy and, if needed, tests that check pH
People with gastroesophageal reflux disease, or GERD, can present with classic symptoms such as burning sensation behind their sternum associated with occasional regurgitation and nausea.
In elderly people, the presentation of GERD may be more subtle and they may present with complications of GERD such as luminal narrowing due to scar tissue formation with trouble swallowing or precancerous lesions called Barrette’s esophagus, which is the development of intestinal tissue replacing normal lining layer of esophagus.
In younger people, particularly young children, nausea and vomiting as well as poor appetite are more common symptoms compared to adults who present with classic symptoms of GERD.
Other less frequent symptoms are trouble swallowing and atypical chest pain as well as hoarseness with sore throat with occasional dental caries.
To diagnose GERD, we can try to treat the patient with typical symptoms.
Other diagnostic tests include endoscopy looking for pathological damage on biopsy or more specific and specialized tests such as pH monitoring.
In pH monitoring, we measure 48 hr acid exposure in the lower esophagus by placement a small device in the esophagus while the patient charts his or her symptoms carrying a belt which receives signals from the device.
These tests are more appropriate for the people who do not respond to acid reducing therapy for 4 weeks or have atypical symptoms.
Also, any patient with alarm symptoms with GERD such as bleeding, low blood count, trouble swallowing and weight loss, endoscopy should be done initially before empirical therapy with acid reducing medication.
During Endoscopy, only 50 percent of people have evidence of tissue damage to esophagus and the remaining 50 percent have normal esophagus who need more specialized tests as was mentioned to diagnose GERD.
It is noteworthy to remember there is a large number of individuals who have depression or other underlying emotional disorders who do not respond to therapy and all their tests will be normal who might benefit from anti-depressive medications.
We also should keep in mind people with motility disorder such as Achalasia, which is inadequate relaxation of the sphincter between the esophagus and stomach, causing trouble swallowing, and food allergy called eosinophilic esophagitis can manifest with reflux symptoms, but the underlying mechanisms are different from GERD.
Interstingly, half of people with eosinophilia esophagitis also respond to strong medication used for acid reduction in esophagus before considering food elimination or using inhalar steroid.
In elderly people, the presentation of GERD may be more subtle and they may present with complications of GERD such as luminal narrowing due to scar tissue formation with trouble swallowing or precancerous lesions called Barrette’s esophagus, which is the development of intestinal tissue replacing normal lining layer of esophagus.
In younger people, particularly young children, nausea and vomiting as well as poor appetite are more common symptoms compared to adults who present with classic symptoms of GERD.
Other less frequent symptoms are trouble swallowing and atypical chest pain as well as hoarseness with sore throat with occasional dental caries.
To diagnose GERD, we can try to treat the patient with typical symptoms.
Other diagnostic tests include endoscopy looking for pathological damage on biopsy or more specific and specialized tests such as pH monitoring.
In pH monitoring, we measure 48 hr acid exposure in the lower esophagus by placement a small device in the esophagus while the patient charts his or her symptoms carrying a belt which receives signals from the device.
These tests are more appropriate for the people who do not respond to acid reducing therapy for 4 weeks or have atypical symptoms.
Also, any patient with alarm symptoms with GERD such as bleeding, low blood count, trouble swallowing and weight loss, endoscopy should be done initially before empirical therapy with acid reducing medication.
During Endoscopy, only 50 percent of people have evidence of tissue damage to esophagus and the remaining 50 percent have normal esophagus who need more specialized tests as was mentioned to diagnose GERD.
It is noteworthy to remember there is a large number of individuals who have depression or other underlying emotional disorders who do not respond to therapy and all their tests will be normal who might benefit from anti-depressive medications.
We also should keep in mind people with motility disorder such as Achalasia, which is inadequate relaxation of the sphincter between the esophagus and stomach, causing trouble swallowing, and food allergy called eosinophilic esophagitis can manifest with reflux symptoms, but the underlying mechanisms are different from GERD.
Interstingly, half of people with eosinophilia esophagitis also respond to strong medication used for acid reduction in esophagus before considering food elimination or using inhalar steroid.
See a gastroenterologist for an endoscopy to rule out Barrett ‘s esophagus which is a precancerous condition and often masked by taking meds like Omeprazole.
Your symptoms are similar to GERD. If you have had these symptoms for over 6 weeks, then please do not ignore them. Consult a physician. GERD symptoms can be associated with other serious medical conditions as well.
