Diagnostic Testing for GERD
What if GERD symptoms persist?
If your GERD symptoms do not improve with lifestyle changes or medications, you may need additional tests.
What type of test will I need?
Barium swallow
Radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. This test is sometimes called a upper GI or UGI. With this test, you drink a solution and then x-rays are taken. The test will not detect mild irritation, although strictures/ narrowing of the esophagus—and ulcers can be observed.
Upper endoscopy
More accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. This procedure is often called a EGD. It is usually performed by a “GI” doctor or Gastroenterologist. These are not surgeons… they are medical doctors who specialize in digestive disorders and non-surgical treatments of the digestive tract. Dr. Gillian does do this procedure but typically only in the operating room.
The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin, flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny camera, the endoscope allows the doctor to see the surface of the esophagus and search for abnormalities. The doctor also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus. The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other problems. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD and medical management with lifestyle modifications and medications may be suggested.
Esophageal Function Testing* ( EFT) formerly called esophageal manometry
Monitors the strength and coordination of the contractions in the esophagus and LES. This test typically takes less than 20 minutes and is used to identify problems with swallowing and to guide surgical and medical management. Dr. Gillian uses this study to determine if abnormal peristalsis in the esophagus is present and how strong the lower esophageal sphincter valve is. This information guides our surgical therapy.
24 Hour pH* monitoring examination
Involves inserting a small recording wire into the esophagus that will stay there for 24 hours. While you go about your normal activities, the device measures when and how much acidic and non-acidic fluid is refluxing into your esophagus. It can even determine how high it gets in your throat. This test is very useful when combined with a symptom diary. Dr. Gillian’s team was the first in the region to combine the pH study with the impedance technology which even allows the recording of non-acidic reflux. This allows the doctor to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.
PEPTest
Pepsin is an enzyme that our body uses to breakdown proteins as part of the digestive process. It is found in the stomach but not in the mouth or esophagus. When detected in saliva it proves that gastric fluid has refluxed to the mouth or upper esophagus. It is a very helpful test when we are trying to determine if LPR is present. We are one of the few centers in the USA to offer this test. Click to see the Peptest brochure
The perfect diagnostic test for GERD does not exist. The tests mentioned above all have their strengths and weaknesses. It often takes a combination of tests and physician evaluations to accurately determine the cause of symptoms and to design and implement an appropriate therapy to control those symptoms and repair any damage from chronic reflux.
PEP Test information
The original test had to come from this site in the United Kingdom – PepTest website. However you can now order an at home test kit and get more information if you wish to from this site – Pepsin Test Kit
Dedicated Heartburn Centers provide studies and expertise so that physicians from a variety of specialties can make sure that their patients are getting the most precise diagnoses and interventions for the problems they are experiencing from reflux and esophageal motility disorders.
Dr Gillian and his staff have been running building and running Heartburn Centers in this region since 1999. First at Southern Maryland Hospital, then at INOVA Alexandria Hospital and Virginia Hospital Center. After evaluating many thousands of patients in our centers we decided to move our center and staff back to Virginia Hospital Center in the summer of 2023. We are excited to be moving forward with a new spacious facility with the latest generation of diagnostic equipment and enthusiastic support from the staff and administration at Virginia Health System. We will still provide a limited coverage for these studies at INOVA Alexandria Hospital Center going forward
Feel free to give the Heartburn Center a call at 703-717-GERD (4373) or call Dr Gillian’s office for more info
click here for –VHC Heartburn Center website
Understanding GERD – a helpful guide.