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Tests and diagnosis
By Mayo Clinic staffA description of your symptoms is often enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult, and requires further testing. You're also likely to have tests to check for damage to your esophagus and stomach as well as for precancerous changes.
Tests may include:
- Endoscopy. A thin, flexible tube with a camera (endoscope) is passed down your throat. The endoscope can show peptic ulcers or inflammation in your stomach and esophagus. Your doctor also may take tissue samples to test for Barrett's esophagus or esophageal cancer.
- Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus. In one test, a thin, flexible tube (catheter) with a probe at the end is threaded through your nose into your esophagus. In another (the Bravo test), the probe is attached to the lower portion of your esophagus during endoscopy. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux.
- Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It's helpful for people who regurgitate substances that aren't acidic (such as bile) and can't be detected by an acid probe. As in a standard probe test, esophageal impedance uses a probe that's placed into the esophagus with a catheter.
References
- Mercer DW, Townsend CM, et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/169271004-2/0/1565/453.html?tocnode=54738708&fromURL=453.html. Accessed Jan. 2, 2012.
- Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/das/book/body/165017723-5/902729765/1389/357.html#4-u1.0-B1-4160-0245-6..50054-8--cesec51_2169. Accessed Jan. 2, 2012.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/. Accessed Dec. 31, 2011.
- Kiefer D. Gastroesophageal reflux disease. In: Rakel RE. Integrative Medicine. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/165168078-5/903199144/1494/89.html#4-u1.0-B978-1-4160-2954-0..50046-6_2173. Accessed Jan. 2, 2012.
- Wang DH, et al. Aberrant epithelial-mesenchymal hedgehog signaling characterizes Barrett's metaplasia. Gastroenterology. 2010;138:1810.
- Richter JE. Role of the gastric refluxate in gastroesophageal reflux disease: acid, weak acid and bile. American Journal of the Medical Sciences. 2009;338:89.
- Yamada T, et al. Bile-acid-induced calcium signaling in mouse esophageal epithelial cells. Biochemical and Biophysical Research Communications. 2011;414:789.
- Cheng P, et al. Effects of refluxate pH values on duodenogastroesophageal reflux-induced esophageal adenocarcinoma. World Journal of Gastroenterology. 2011;17:3060.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 15, 2012.
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