Extensive testing may not be needed in all people who have symptoms of gastroesophageal reflux disease (GERD). A doctor may first ask you questions about your symptoms, such as whether you have a frequent uncomfortable feeling of burning, warmth, heat, or pain just behind the breastbone, commonly referred to as heartburn. If you have frequent, severe episodes of heartburn, your doctor may prescribe medications normally used to treat symptoms of GERD without performing any other tests. If your symptoms get better with these medications, your doctor will usually diagnose you as having GERD.

Depending on your symptoms, your doctor may refer you to a specialist (such as a gastroenterologist) for a test called an upper gastrointestinal endoscopy. This allows your doctor to look at the inner lining of your esophagus, stomach, and the first part of your small intestine (duodenum) through a thin, flexible viewing instrument called an endoscope.

Endoscopy is used to:

• Evaluate the esophagus for inflammation (esophagitis) and other complications that may be caused by GERD, including bleeding or narrowing of the esophagus (stricture).
• Rule out Barrett's esophagus, which is a complication of GERD. Endoscopy is the only reliable method for diagnosing Barrett's esophagus, which cannot be seen on X-rays or other types of tests. Biopsy, a sample of tissue collected from an organ or other part of the body, may also be used to rule out Barrett's esophagus.
• Rule out other diseases such as ulcers or cancer that can cause symptoms similar to GERD.

Your health professional may use an endoscope to collect a tissue sample (biopsy) to test for Helicobacter pylori (H. pylori) bacteria as well. H. pylori causes peptic ulcers, which are craterlike sores that develop in the lining of the stomach or small intestine.

Other tests

If endoscopy does not provide enough evidence that GERD is causing your symptoms, esophageal tests may be done. Esophageal tests may be recommended if your GERD symptoms do not get better with medication treatment, you have frequent symptoms and are at risk for developing Barrett's esophagus, or you need long-term (chronic) therapy. This testing includes:

• Manometry testing, which determines how well muscles in the esophagus move food into the stomach and how tightly the valve between the esophagus and stomach (the lower esophageal sphincter) closes. Manometry testing is also often required before doing surgery to treat GERD.
• pH monitoring, which tests how often acid from the stomach gets into the esophagus and how long it stays there.

X-ray pictures of the esophagus and stomach are not used to diagnose GERD. But they may be useful for detecting other problems that may be causing GERD symptoms, such as a hiatal hernia or a narrowing in the esophagus (stricture). These X-rays may be done as part of a series of tests called an upper gastrointestinal series.

The tests your doctor may recommend are based on your specific GERD symptoms. Before agreeing to have more GERD testing, ask your doctor what information the test is expected to provide and how the results will change your treatment.