Your description of your symptoms may be all a doctor requires to diagnose heartburn, but sometimes additional testing may be necessary. The esophagus can be viewed through an endoscope, a long, thin, flexible tube inserted through the mouth, or by X-ray.
Sometimes, your doctor may recommend a 24-hour esophageal pH probe study, especially if you have unusual symptoms, such as throat or chest or abdominal pain, coughing, or asthma-like symptoms. In this test, a long, narrow, flexible tube is inserted through the nose down into the esophagus and a probe is left there for 24 hours. This probe detects acid levels to determine if it correlates with your symptoms. A newer technique (called Bravo) measures 24-hour acid; it is done using wireless pH sensors, which eliminates the need for a tube insertion. To detect if your heart is the cause of your symptoms, an electrocardiogram (ECG), a recording of the heart's electrical activity, may be taken.
A physical exam for hiatal hernia is similar to that for heartburn, with two additions: X-rays may be ordered to show the hernia, and if anemia is a concern, a blood sample may be taken to check your red blood cell count.
A hiatal hernia can be diagnosed with a specialized X-ray study that allows visualization of the esophagus and stomach (barium swallow) or with endoscopy (a test that allows the doctor to view the hernia directly). An esophageal manometry test (pressure study) may also be performed...
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Jennifer Robinson, MD on August 26, 2014