If your symptoms do not improve with lifestyle changes or medications, you may need additional tests. The tests offered at the Heartburn Center at VHC include:
Reflux Testing (24hr Ambulatory pH & Impedance)
This study is used to determine if you have Gastro-Esophageal Reflux Disease (GERD). It is helpful to evaluate symptoms such as heartburn, hoarseness, chest pain, or regurgitation that may be occurring as a result of GERD. This study involved the doctor or nurse inserting a small tube through your nose into the esophagus which is then connected to a small recording device that stays in place for 24 hours. While you go about your normal activities, the device measures how much acid comes up into your esophagus. This test allows the doctor to see correlations between symptoms and reflux episodes, and is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.
Esophageal Motility Testing (High Resolution impedance Manometry)
This study tests the function of the esophagus when swallowing. It is helpful to evaluate symptoms such as difficulty swallowing, non-cardiac chest pain and often used prior to any antireflux surgery. This study involves the doctor or nurse inserting a small tube through your nose into the esophagus. This is typically not painful but may feel uncomfortable or cause a gag reflex during insertion. However, this usually resolves once the probe is in position. You will then swallow small amounts of fluid while the study is performed.
You may require additional testing such as a Barium swallow radio graph or an upper endocscopy. These tests are can be done at Virginia Hospital Center, and should be scheduled by your referring physician.
Barium swallow radiograph
Barium swallow radiograph uses x-rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. With this test, you drink a solution and then x-rays are taken. The test will not detect mild irritation, although strictures—narrowing of the esophagus—and ulcers can be observed.
Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin, flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny camera, the endoscope allows the doctor to see the surface of the esophagus and search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals the injury to the esophagus, usually no other tests are needed to confirm GERD. The doctor also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus. The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other problems if infection or abnormal growths are not found.
The perfect diagnostic test for GERD does not exist. The tests mentioned above all have their strengths and weaknesses. It often takes a combination of tests and physician evaluations to accurately determine the cause of symptoms and to design and implement an appropriate therapy to control those symptoms and repair any damage from chronic reflux.