Testing for GERD
If you are taking medications for gastroesophageal reflux disease (GERD) but are one of the 40% of people on those meds who still have symptoms, make sure that you really have reflux. Many who are being treated for GERD actually do not have that disease. Less than 1% of people who take daily Proton Pump Inhibitors (PPI’s) are actually evaluated with specific tests for reflux. Upper endoscopy is important but is not diagnostic of GERD.
At the South Florida Reflux Center, we are excited to offer the latest, state of the art tools to diagnose the true cause of your symptoms. Fully evaluating the function of your esophagus and measuring the extent of your gastroesophageal reflux is the only way to ensure that you will receive the best treatment for your symptoms and their cause.
24-hour pH and impedance testing:
This is a study that directly measures the material from the stomach that refluxes up into the esophagus, the actual definition of gastroesophageal reflux. Gas, liquids and solid material can be measured. It will detect the material whether it is acid containing or not. This procedure is painless, is performed in our office, and requires no anesthesia. We insert a thin, soft , flexible tube through the nose into the stomach and tape it in place. It is attached by a thin wire to a small device that records the information. By wearing this recorder for 24 hours, we can measure information for a typical day. You press buttons on the recorder to indicate your symptoms and activities. We provide you with a diary, so that you may write down more specific information about your symptoms, and indicate when you are eating or lying down. It is important that during this study, you eat and drink as you normally would. With this test, we can compare your reflux to those without the disease and give you a score that describes the severity of your reflux. We can prove which symptoms truly are caused by GERD. It has the advantage of detecting nonacid material as well as acid, which can allow you to remain on your medications if necessary during the study. However, the study gives the most information if you do not take your antacid medications before and during the procedure. If you take medications knows as proton pump inhibitors (PPI’s) like Omeprazole (Prilosec) or Protonix (Pantoprazole), you should hold them 7 days before the procedure. H2 blockers like Pepcid, Zantac or Cimetadine should be held for 48 hours prior to testing. The day after insertion, you will return to the office so that we may painlessly remove the device and upload the data for interpretation.
Bravo 48 hour pH testing:
48 hour Bravo pH testing is similar to the 24 hour pH and impedance testing in that it can measure acid that arises from the stomach and refluxes up the esophagus. However, it can only measure acid fluid. It must be inserted under anesthesia with an endoscopy performed to check its placement. It is most reliably placed after completing an esophageal manometry which can determine the best location to attach the probe. It does have the advantage of recording data for 48 hours and is wireless with no tubes attached to the person. Similar to 24 hour nasal pH and impedance testing, the patient has a recorder and diary to record symptoms, eating and laying down. With this test, we can compare your acid reflux to those without the disease and give you a score that describes the severity of your acid reflux. . We can prove which symptoms truly are caused by GERD. You must be off proton pump inhibitor medications (PPI’s) for at least 5-7 days before the test and during the test. Other medication called H2 blockers should be stopped at least 48 hours before the test. You should not take even short acting antacids during the study. It is important that during this study, you eat and drink as you normally would. Some patients may feel discomfort or pain from the attached probe. The probe falls off after a few days and does not need to be retrieved. The recorder does have to be returned so that we may upload data.
Esophageal manometry testing:
Esophageal manometry is a test used to assess the pressure and motor function of the esophagus. Manometry is essential in evaluating how well the muscles of the esophagus move food into the stomach.. It measures how often the swallows fail, and how strong and organized are the contractions or squeezing of your esophagus. It measures the function of the muscular valves at the top and bottom of the esophagus, and how well the swallowed bolus clears the esophagus. This test also measures the size of hiatal hernias. Manometry is an important test which can diagnose problems with the esophagus that can cause symptoms often confused with reflux, or which worsens the symptoms of reflux. The treatment for an abnormal esophagus often differs from the treatment for reflux disease. Even if the patient has GERD, the strength and the ability of the esophagus to move food along can impact the treatment for GERD. Magnetic sphincter augmentation (LINX), for example needs the esophagus to have a certain minimum strength to avoid problems or pain with swallowing, (dysphagia or odynophagia). Manometry expertly performed and read is important for selecting the best treatment for reflux. This procedure is performed in the office at the South Florida Reflux Center. We do apply a topical anesthetic to the nose to improve the comfort of our patient. Otherwise, no anesthesia or special monitoring of the patient is needed. The catheter is inserted, the patient is instructed to swallow ten times, and the probe is then removed. The complete procedure takes 15-20 minutes.
The video esophagram, also known as an upper GI or a barium swallow, is an X-ray based test that shows the swallow in real time. It is performed in the radiology department as an outpatient without anesthesia. It can reveal narrowing or strictures, tumors, and pouches which are called diverticuli.It provides information about how well the esophagus functions, and looks at the muscular valves. It can show a hiatal hernia. When specific protocols are followed by experienced radiologists, it can be reliable in showing that the esophagus is normal. It is not sensitive for showing reflux, but it often does show reflux. If abnormal, further testing such as manometry is essential. For patients who complain of difficulty swallowing or pain with eating, it is a good test, but not the only test that should be used to evaluate the patient. I find that in combination with manometry and endoscopy, a complete picture of esophageal function and the hiatal hernia can be obtained.
EGD also called upper endoscopy, is a commonly used test to visualize the inside of the esophagus and stomach. Under some form of anesthesia, a flexible tube attached to a camera is inserted through the mouth into the esophagus and stomach. It can detect pouches, narrowing ulcers and tumors of the esophagus, stomach and duodenum. The physician can biopsy tissue, which means that a portion of the lining can be removed and sent to a pathologist to evaluate. Cancer and precancerous cells can be found. The biopsy can find evidence of inflammation that can be missed just by looking alone. Often patients who complain of GERD, will have an endoscopy. This is an essential test to ensure there are no cancers causing the symptoms. If precancerous lesions are found, steps can be taken to prevent or closely monitor for the development of cancer. It is imperative that patients with recurrent symptoms of GERD have at least one endoscopy. However, reflux is often missed by EGD alone. Severe, symptomatic reflux can occur in patients without causing Inflammation, ulcers or thickening of the lining of the esophagus. This means that reflux can exist without significant findings on EGD.