Diagnosis of GERD
Given how common gastro-esophageal reflux disease is, many patients are initially diagnosed and treated based solely on their history of symptoms. Many patients are already on an over-the-counter medication before they seek medical attention. If the reflux is mild enough that it completely resolves with over-the-counter medications, often no further work up is pursued. However, it is important to remember that although the symptoms are treated with medications, the actual reflux of stomach contents never stops, meaning that damage to the esophagus could be happening “silently.”
The Reflux Center at Brandon Regional Hospital offers all diagnostic methods at one location, minimizing the number of appointments.Expand All Collapse All
Esophago-gastro-duodenoscopy (EGD) is the most valuable initial method of diagnostic testing performed on patients with GERD because of the volume of information that can be obtained at one time. It is a procedure in which a tube-camera is placed through the mouth to visualize the esophagus, stomach and duodenum (small intestine). Our skilled gastroenterologists perform this procedure under sedation in order to keep patients comfortable through the procedure.
Often the esophagus of patients with reflux looks normal. However, in moderate to severe cases, the lining of the esophagus appears inflamed (esophagitis). Endoscopy can also rule out any tumors or strictures (narrowing) of the esophagus. The presence of esophagitis on medical therapy signifies poorly treated reflux, which should be further evaluated. If there is an abnormal transformation of the lining of the esophagus, the gastroenterologist will biopsy the area to rule out Barrett’s esophagus or esophageal cancer. An EGD also evaluates the stomach and first portion of the small intestine (duodenum) for tumors or ulcers.
The pH probe study is the most specific test for acid reflux. This study measures the frequency and duration of acidic fluid refluxing into the esophagus.
Standard procedure for this study is performed by placing a tube in a patient's nose, resting in their esophagus. The patient goes home with a tube in the nose, to remain in place for 24 hours. Patients are unable to shower and are quite uncomfortable.
New Alternative: The BRAVO pH Probe
Here at The Reflux Center, we have invested in the latest advance in pH testing -- the Bravo pH probe, which is a wireless capsule that is implanted just above the LES (Lower Esophageal Sphincter). This allows our patients to go on with their normal daily activities without the cumbersome tube in their nose while we are able to obtain 24-48 hours worth of data measuring the acid exposure to the esophagus. This wireless capsule then transmits to a receiver that the patient clips on their clothing. During the day, the patient presses a button on the receiver when they are having symptoms. This enables us to correlate moments of acid reflux with symptoms. The capsule releases itself within one to two weeks and is excreted uneventfully.
Esophageal manometry is a study used to assess esophageal function; it is performed by our specially trained nurses here at The Reflux Center.
A thin, pressure-sensitive tube is passed through your mouth or nose into your stomach. When the tube is in your esophagus, you are asked to swallows sips of water. The pressures of the muscle contractions are measured along the length of your esophagus. Upon completion of the test, the tube is removed. The study takes 30 to 60 minutes to perform.
Manometry is used to measure the effectiveness of the LES at preventing reflux. Also with the information obtained, we are able to diagnose and differentiate other conditions such as esophageal dysmotility syndromes, achalasia and presbyesophagus.
Manometry can identify when laparoscopic fundoplications or incisionless Transoral Incisionless Fundoplication (TIF) are viable treatment options for GERD and which type of procedure is the best option.
During an esophagram, a patient drinks either barium or a water based contrast that coats the upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.
This study is the best study to evaluate the size and shape of a hiatal hernia and the position of the lower esophageal sphincter. This study is also helpful in seeing complications of reflux such as esophageal strictures and ulcers throughout the upper gastrointestinal tract.
Our skilled radiologists can also diagnose moderate to severe reflux and assess esophageal function based on observing the real-time video images during the exam.
Gopal Grandhige, MD