Heartburn (GERD)

How Are GERD And Hiatal Hernia Diagnosed?

Doctors can often diagnose GERD just on the basis of symptoms that individuals with the disease describe. Primary care doctors are very familiar with the symptoms of GERD and can diagnose and treat most cases. Some individuals, however, may require care from gastroenterologists, doctors who specialize in GERD and other diseases of the digestive system.

If the symptoms are relatively mild, the doctor may first try treatment before performing tests. However, if the symptoms continue, or get worse, tests can determine what is causing the problem.

Barium x-rays

Endoscopic examination

Barium X-rays

Barium x-rays, also called an “upper GI series,” are x-rays of the upper gastrointestinal tract. The procedure is performed as follows:

• The patient swallows a drink containing barium, a material that is visible on x-rays. Barium coats the inner lining of the esophagus and stomach and gives them a white highlighted appearance. The individual having the x-ray usually has to fast several hours in advance, so the stomach is empty and clearly visible.
• The radiologist watches the flow of barium as the patient swallows. He checks to see whether the esophagus and stomach are normal. Hiatal hernias, narrowing of the esophagus, ulcers, and other problems may be clearly visible. The radiologist also may tilt the examining table slightly so that the patient’s head is slightly lower than the feet. That position encourages reflux of the stomach contents into the esophagus. Reflux may be visible as a backward flow of the white-colored barium.

Endoscopic Examination

Endoscopic examination of the esophagus and stomach is performed by the doctor passing a thin, flexible tube through the mouth and into the esophagus and stomach. The tube is called an endoscope, an instrument with a tiny viewing camera at the end that allows the doctor to see the esophagus and stomach directly. By passing mini-instruments through the channel in the endoscope, the doctor also can take samples of tissue for examination under a microscope.

Acid Testing

Certain tests (the “Bernstein Test” and others) can be performed to determine if the symptoms originate from acid in the esophagus. Testing for acidity levels (pH) over a 24-hour period may also give the doctor more information that will help in selecting the most appropriate treatment.