Diagnosing Acid Reflux Disease

Three out of every 10 people experience heartburn on occasion. So it can be somewhat arbitrary to decide when heartburn should be called acid reflux disease. Also known as gastroesophageal reflux disease (GERD), this is a chronic irritation of the lining of a person's esophagus by stomach acid. Usually it's just annoying. GERD can, however, have serious consequences, including esophagitis and Barrett's esophagus. Barrett's esophagus is a condition that increases the likelihood of esophageal cancer.

What are the symptoms of acid reflux disease?

People with acid reflux disease often have some or all of the following symptoms:

• pain when swallowing
• bad breath and/or bad taste in the mouth
• burping
• chest pain
• heartburn
• hoarseness
• regurgitation
• sore throat

To diagnose acid reflux disease, symptoms must be present at least twice a week on a regular basis.

How is acid reflux diagnosed?

If you experience classic symptoms of acid reflux disease -- chronic heartburn and regurgitation -- without any troublesome complications, it may be relatively easy for your doctor to make an acid reflux diagnosis.

A few people have GERD that doesn't respond to treatment. Or they may have other concerning symptoms such as weight loss, difficulty swallowing, anemia, or black stools. If you're one of them, you may need any of the following tests.

Diagnosing acid reflux: Barium swallow radiograph

Your doctor may decide to use a special X-ray procedure to rule out any structural problems in your esophagus. In this painless acid reflux test, you will be asked to swallow a solution of barium. The barium enables doctors to take a clearer X-ray of your esophagus.

Barium swallow isn't a surefire method of diagnosing GERD. Only one out of every three people with GERD has esophageal changes that are visible on X-rays.

Diagnosing acid reflux: Endoscopy or EGD

In this test, the doctor inserts a small tube with a camera on the end through the mouth into the esophagus. This enables the doctor to see the lining of the esophagus and stomach.

Before inserting the tube, your gastroenterologist may administer a mild sedative to help you relax. The doctor may also spray your throat with an analgesic spray to make the procedure more comfortable for you.

This acid reflux test typically lasts about 20 minutes. It is not painful and will not interfere with your ability to breathe.

While this test may detect some complications of GERD, including Barrett's esophagus, only about half the people with acid reflux disease have visible changes to the lining of their esophagus.

Diagnosing acid reflux: Biopsy

Depending on what the EGD shows, your doctor may decide to perform a biopsy during the procedure. If this is the case, your gastroenterologist will pass a tiny surgical instrument through the scope to remove a small piece of the lining in the esophagus. The tissue sample will then be sent to a pathology lab for analysis. There it will be assessed to see if there is an underlying disease such as esophageal cancer.