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Acid Reflux
How is Acid Reflux diagnosed
and evaluated?
The usual way that GERD is
diagnosed-or at least suspected-is by its
characteristic symptom, heartburn. Heartburn
is most frequently described as a sub-sternal
(under the middle of the chest) burning that
occurs after meals and often worsens when
lying down. To confirm the diagnosis,
physicians often treat patients with
medications to suppress the production of
acid by the stomach. If the heartburn then
is diminished to a large extent, the
diagnosis of GERD is considered confirmed.
This approach of making a diagnosis on the
basis of a response of the symptoms to
treatment is commonly called a therapeutic
trial.
There are problems with this approach,
however, primarily because it does not
include diagnostic tests. For instance,
patients who have conditions that can mimic
GERD, specifically duodenal or gastric
(stomach) ulcers, also can actually respond
to such treatment. In this situation, if the
physician assumes that the problem is GERD,
he or she will not look for the cause of the
ulcer disease. For example, a type of
infection called Helicobacter pylori, or
non-steroidal anti-inflammatory drugs (e.g.,
ibuprofen), can also cause ulcers and these
conditions would be treated differently from
GERD.
Moreover, as with any treatment, there is perhaps a 20% placebo
effect, which means that 20% of patients will respond to a placebo
(inactive) pill or, indeed, to any treatment. This means that 20% of
patients who have causes of their symptoms other than GERD (or ulcers) will have a decrease in
their symptoms after receiving the treatment
for GERD. Thus, on the basis of their
response to treatment (the therapeutic
trial), these patients then will continue to
be treated for GERD, even though they do not
have GERD. What's more, the true cause of
their symptoms will not be pursued further.
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Endoscopy
Upper gastrointestinal endoscopy (also known
as esophago-gastro-duodenoscopy or EGD) is a
common way of diagnosing GERD. EGD is a procedure
in which a tube containing an optical system
for visualization is
swallowed. As the tube progresses down the
gastrointestinal tract, the lining of the
esophagus, stomach, and duodenum can be
examined.
The esophagus of most patients with symptoms
of reflux looks normal. Therefore, in most
patients, endoscopy will not help in the
diagnosis of GERD. However, sometimes the
lining of the esophagus appears inflamed (esophagitis).
Moreover, if erosions (superficial breaks in
the esophageal lining) or ulcers (deeper
breaks in the lining) are seen, a diagnosis
of GERD can be made. Endoscopy will also
identify several of the complications of
GERD, specifically, ulcers, strictures, and
Barrett's esophagus. Biopsies also may be
obtained. Finally, other problems that may
be causing GERD-like symptoms-for example
ulcers, inflammation, or cancers-can be
diagnosed in the stomach or duodenum.
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Biopsies
Biopsies of the esophagus that are obtained
through the endoscope are not very useful
for diagnosing GERD. They are useful,
however, in diagnosing cancers or causes of
esophageal inflammation other than acid
reflux, particularly infections. Moreover,
biopsies are the only means of diagnosing
the cellular changes of Barrett's esophagus.
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X-rays
Before the introduction of endoscopy, an
x-ray of the esophagus (called an esophagram)
was the only means of diagnosing GERD.
Patients swallowed barium (contrast
material), and x-rays of the barium-filled
esophagus were then taken. The problem with
the esophagram was that it was an
insensitive test for diagnosing GERD. That
is, it failed to find signs of GERD in many
patients who had GERD because the patients
had little or no damage to the lining of the
esophagus. The x-rays were able to show only
the infrequent complications of GERD, for
example, ulcers and strictures. X-rays have
been abandoned as a means of diagnosing GERD,
although they still can be useful in
addition to endoscopy in the evaluation of
complications.
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Examination of the throat and larynx
When GERD affects the throat or larynx and
causes symptoms of cough, hoarseness, or
sore throat, patients often visit an ear,
nose, and throat (ENT) specialist. The ENT
specialist frequently finds signs of
inflammation of the throat or larynx.
Although diseases of the throat or larynx
usually are the cause of the inflammation,
sometimes GERD can be the cause.
Accordingly, ENT specialists often try
acid-suppressing treatment to confirm the
diagnosis of GERD. This approach, however,
has the same problems that, as discussed
above, result from using the response to
treatment to confirm GERD.
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next 4 methods to diagnosed Acid Reflux
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