Diagnosis of GERD is often based on symptoms. It is characterized by chronic intermittent heartburn as a burning sensation in the chest and throat as well as acid regurgitation presenting as a sensation of acid in the throat or mouth. GERD may also present with atypical symptoms of esophageal and extra-esophageal origin such as chronic cough, sleep disturbance, chest pain, asthma, and hoarseness.12 In fact, one study showed that 50% of individuals with noncardiac chest pain had abnormal pH tests or positive endoscopy confirming the presence of GERD.13 A positive response to PPI therapy is frequently used to confirm the diagnosis of GERD. Additional diagnostic tests are performed for an individual with an atypical presentation, a high risk for complications, or a poor response to initial therapy. Initially, a barium swallow and upper GI series are commonly performed. Esophageal pH monitoring is an important diagnostic tool for GERD. Ambulatory pH monitoring detects abnormal levels of acid in the esophagus and can be used to correlate esophageal acid exposure with symptoms. The Bravo capsule is a wireless pH monitoring device that has been shown to be more tolerable, accurate, and sensitive than the catheter-based pH monitoring. The Bilitec system measures duodeno-gastroesophageal reflux by evaluating bilirubin absorbance; this system is useful particularly for the subset of patients that may be affected by duodenogastroesophageal reflux. These patients report reflux symptoms with normal acid exposure in the esophagus on high-dose PPI therapy. Intraluminal impedance monitoring detects the composition, distribution, and clearing of both acid and nonacid esophageal reflux. Combined esophageal pH-impedance monitoring allows detection of nearly all gastroesophageal reflux episodes, acid as well as nonacid, which provides better diagnostics, particularly with patients on acid-suppression therapy.14 Esophageal manometry is also performed to measure the pressure at the LES. Esophagoscopy, more commonly called endoscopy, is used to diagnose esophagitis, and a biopsy can differentiate esophageal strictures from cancer. Endoscopy should be performed on patients with chronic GERD symptoms to rule out Barrett's esophagus.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.