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Read moreNHS Choices - Diagnosing gastro-oesophageal reflux disease
(27/06/2014)
In most cases, your GP will be able to diagnose gastro-oesophageal reflux disease (GORD) by asking you about your symptoms.
Further testing for GORD is usually only required if:
- you have pain when swallowing (odynophagia)
- you have difficulty swallowing (dysphagia)
- your symptoms don't 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 functional dyspepsia (irritation of the stomach or gullet) or irritable bowel syndrome (IBS).
You may also have a full blood count (FBC) to exclude the possibility of anaemia.
Endoscopy
An endoscopy is a procedure where the inside of your body is examined using an endoscope, which is a long, thin, flexible tube with a light and camera at one end.
To confirm a diagnosis of GORD, the endoscope will be gently inserted into your mouth and down your throat. The procedure is usually carried out while you're awake, and you may be given a sedative to help you relax.
The camera can then show if 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
Manometry is used to assess how well your lower oesophageal sphincter (LOS) is working, by measuring pressure levels inside the sphincter muscle.
During the procedure, one of your nostrils will be numbed using a topical anaesthetic. A small tube will be passed down your nostril, into your oesophagus, to the site of the LOS. The tube contains pressure sensors that can detect the pressure generated by the muscle and then send the reading to a computer.
You will be asked to swallow some food and liquid to check how effectively your LOS is working.
A manometry test takes around 20 to 30 minutes to complete. It's not painful, but you may experience minor side effects, including a sore throat or a nosebleed. These side effects should pass quickly once the test has been completed.
Manometry isn't essential for diagnosing GORD, but it can help exclude conditions with similar symptoms. It can also help ensure that the strength of gullet contractions are adequate if surgery is being considered.
Barium swallow
If you're experiencing symptoms of dysphagia, such as coughing or choking when eating or drinking, 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 won't 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.
After this, you will be asked to lie on a couch and your specialist will give you a white, chalky liquid to drink that 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. During the test, the couch may be angled slightly so that the barium fills all the areas of your stomach.
A barium swallow usually takes about 15 minutes. Afterwards, you will be able to eat and drink normally, although you may need to drink more water to help flush the barium out of your system.
You may feel slightly sick after having 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 it's still unclear whether your symptoms are due to GORD after having an endoscopy, 24-hour pH monitoring will be recommended to help confirm the diagnosis. PH is a unit of measurement that describes how acidic a solution is; the lower the pH, the more acidic the solution.
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, as it 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 isn't usually painful, but it can feel a little uncomfortable.
The probe is connected to a portable recording device that is 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.
After this, you will be asked to complete a diary sheet to record when you display symptoms. You should eat as you normally would to ensure that an accurate assessment can be made.
After the 24-hour period is over, the probe will be removed and the measurements on the recorder will be analysed. If test results indicate a sudden rise in your pH levels after eating, a confident diagnosis of GORD can usually be made.