What if GERD symptoms persist?

If your symptoms do not improve with lifestyle changes or medications, you may need additional tests

Barium swallow radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. 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 is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. 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. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus then GERD may be the cause.

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 that can be determined by the pathologist.  Esophagitis, Barrett’s disease, Infections and even Cancer may be determined in this manner which allows appropriate treatment to start quickly.

Esophageal Function Testing ( EFT) formerly called esophageal manometry is used to monitor 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.

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. 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™ This is a special assay that we order for patients to help clarify wether or not they may have reflux that is affecting their vocal cords. It is a unique study that allows us to determine if there are digestive enzymes in their saliva (Pepsin) which could only get their if it was refluxed by the stomach.   This is sometimes the “tiebreaker” test to help us decide if surgery will help our patients. Particularly those with LPR or laryngeal pharyngeal reflux. We have a special relationship with the company in the UK that does this study as it is not offered in the USA. There are only a handful of places in this country where the study is available.  For more information give us a call or take a look at the Peptest™ Website.

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.

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