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Tests and diagnosis
By Mayo Clinic staffDoctors often can diagnose a reflux problem from a description of symptoms. 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.
- Endoscopy. In this test, your doctor passes a thin, flexible tube with a light and camera (endoscope) down your throat. The endoscope can show ulcerations or inflammation in your stomach or esophagus and can reveal a peptic ulcer. The test, technically called an esophagogastroduodenoscopy (EGD), also allows your doctor to take tissue samples to test for Barrett's esophagus — a condition in which cells in the esophagus undergo precancerous changes — or esophageal cancer, two potential complications of acid and bile reflux.
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Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus. Because these tests look for the presence of acid, they're useful for diagnosing acid reflux. Ambulatory acid tests are negative in people with bile reflux.
In the standard tube test, a thin, flexible tube (catheter) with a probe at the end is threaded through your nose into your esophagus. The probe is placed just above the lower esophageal sphincter. A second probe may be placed in your upper esophagus. Attached to the other end of the catheter is a small computer that you wear around your waist or over your shoulder during the test. After the probe is in place, you go about your daily routine, the device records acid (pH) levels for 24 hours, and then you return to have the device removed.
The test is somewhat uncomfortable, makes sleeping and showering difficult, and eating a highly acidic meal can skew the results. Tests are available that may be more comfortable, however. The Bravo test, for example, eliminates the need for a nose tube because the probe is attached to the lower portion of your esophagus during endoscopy. And rather than having to be removed, the probe detaches in a timely manner on its own and passes through your intestinal tract.
- Esophageal impedance. Rather than measuring acid, this test can measure whether gas or liquids reflux into the esophagus. It's helpful for people who have regurgitation of substances that aren't acidic and therefore wouldn't be detected by a pH probe. As in a standard probe test, esophageal impedance uses a probe that's placed into the esophagus with a catheter.
- Mercer DW, et al. Peptic ulcer disease. In: Townsend CM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/169271004-2/0/1565/453.html?tocnode=54738708&fromURL=453.html. Accessed Oct. 15, 2009.
- Lee EL, et al. Gastritis and gastropathies. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. 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 Oct. 15, 2009.
- Dawson PA. Bile secretion and the enterohepatic circulation. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2006. http://www.mdconsult.com/das/book/body/1650177237/0/1389/450.html?tocnode=51640881&fromURL=450.html#4-u1.0-B1-4160-0245-6..50066-4_2774. Accessed Oct. 15, 2009.
- Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD). National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/. Accessed Oct. 15, 2009.
- Yardley JH, et al. Acute hemorrhagic erosive gastropathy and chronic chemical gastropathy. http://www.uptodate.com/home/index.html. Accessed Oct. 15, 2009.
- Fass R. Approach to refractory gastroesophageal reflux disease in adults. http://www.uptodate.com/home/index.html. Accessed Oct. 15, 2009.
- 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 Oct. 15, 2009.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 24, 2009.
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