Diagnosis of GER & GERD

How do doctors diagnose GER?

In most cases, your doctor diagnoses gastroesophageal reflux (GER) by reviewing your symptoms and medical history. If your symptoms don’t improve with lifestyle changes and medications, you may need testing.

How do doctors diagnose GERD?

If your GER symptoms don’t improve, if they come back frequently, or if you have trouble swallowing, your doctor may recommend testing you for gastroesophageal reflux disease (GERD).

Your doctor may refer you to a gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Several tests can help a doctor diagnose GERD. Your doctor may order more than one test to make a diagnosis.

Upper gastrointestinal (GI) endoscopy and biopsy

In an upper GI endoscopy, a gastroenterologist, surgeon, or other trained health care professional uses an endoscope to see inside your upper GI tract. This procedure takes place at a hospital or an outpatient center.

An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. In some cases, the procedure can be performed without sedation. You will be given a liquid anesthetic to gargle or spray anesthetic on the back of your throat. The doctor carefully feeds the endoscope down your esophagus and into your stomach and duodenum. A small camera mounted on the endoscope sends a video image to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see.

The doctor may perform a biopsy with the endoscope by taking a small piece of tissue from the lining of your esophagus. You won’t feel the biopsy. A pathologist examines the tissue in a lab.

In most cases, the procedure only diagnoses GERD if you have moderate to severe symptoms.

Read more about upper GI endoscopy.

Upper GI series

An upper GI series looks at the shape of your upper GI tract.

An x-ray technician performs this procedure at a hospital or an outpatient center. A radiologist reads and reports on the x-ray images. You don’t need anesthesia. A health care professional will tell you how to prepare for the procedure, including when to stop eating and drinking.

During the procedure, you will stand or sit in front of an x-ray machine and drink barium to coat the inner lining of your upper GI tract. The x-ray technician takes several x-rays as the barium moves through your GI tract. The upper GI series can’t show GERD in your esophagus; rather, the barium shows up on the x-ray and can find problems related to GERD, such as

You may have bloating and nausea for a short time after the procedure. For several days afterward, you may have white or light-colored stools from the barium. A health care professional will give you instructions about eating, drinking, and taking your medicines after the procedure.

Esophageal pH and impedance monitoring

The most accurate procedure to detect acid reflux is esophageal pH and impedance monitoring. Esophageal pH and impedance monitoring measures the amount of acid in your esophagus while you do normal things, such as eating and sleeping.

A gastroenterologist performs this procedure at a hospital or an outpatient center as a part of an upper GI endoscopy. Most often, you can stay awake during the procedure.

A gastroenterologist will pass a thin tube through your nose or mouth into your stomach. The gastroenterologist will then pull the tube back into your esophagus and tape it to your cheek. The end of the tube in your esophagus measures when and how much acid comes up your esophagus. The other end of the tube attaches to a monitor outside your body that records the measurements.

You will wear a monitor for the next 24 hours. You will return to the hospital or outpatient center to have the tube removed.

This procedure is most useful to your doctor if you keep a diary of when, what, and how much food you eat and your GERD symptoms are after you eat. The gastroenterologist can see how your symptoms, certain foods, and certain times of day relate to one another. The procedure can also help show whether acid reflux triggers any respiratory symptoms.

Bravo wireless esophageal pH monitoring

Bravo wireless esophageal pH monitoring also measures and records the pH in your esophagus to determine if you have GERD. A doctor temporarily attaches a small capsule to the wall of your esophagus during an upper endoscopy. The capsule measures pH levels in the esophagus and transmits information to a receiver. The receiver is about the size of a pager, which you wear on your belt or waistband.

You will follow your usual daily routine during monitoring, which usually lasts 48 hours. The receiver has several buttons on it that you will press to record symptoms of GERD such as heartburn. The nurse will tell you what symptoms to record. You will be asked to maintain a diary to record certain events such as when you start and stop eating and drinking, when you lie down, and when you get back up.

To prepare for the test talk to your doctor about medicines you are taking. He or she will tell you whether you can eat or drink before the procedure. After about seven to ten days the capsule will fall off the esophageal lining and pass through your digestive tract.

Esophageal manometry

Esophageal manometry measures muscle contractions in your esophagus. A gastroenterologist may order this procedure if you’re thinking about anti-reflux surgery.

The gastroenterologist can perform this procedure during an office visit. A health care professional will spray a liquid anesthetic on the back of your throat or ask you to gargle a liquid anesthetic.

The gastroenterologist passes a soft, thin tube through your nose and into your stomach. You swallow as the gastroenterologist pulls the tube slowly back into your esophagus. A computer measures and records the pressure of muscle contractions in different parts of your esophagus.

The procedure can show if your symptoms are due to a weak sphincter muscle. A doctor can also use the procedure to diagnose other esophagus problems that might have symptoms similar to heartburn. A health care professional will give you instructions about eating, drinking, and taking your medicines after the procedure.

November 2014

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.