Materiały źródłowe

• #1 Diagnosing Gastroesophageal Reflux Disease | NYU Langone Health

  https://nyulangone.org/conditions/gastroesophageal-reflux-disease/diagnosis

  Gastroesophageal reflux disease, or GERD, is a chronic condition in which acid in the stomach and sometimes nonacidic content flows into the esophagus, the tube that carries food from the mouth to the stomach. NYU Langone doctors are highly experienced in diagnosing and treating GERD. […] GERD may also be caused by a hiatal hernia, a condition in which the upper portion of the stomach bulges into the chest cavity through an opening in the diaphragm. […] Its normal to have occasional reflux or heartburn, especially after a heavy meal or when lying down after eating. But if you begin to experience reflux persistently or chronically, it is important to seek evaluation by a gastroenterologist—a doctor who specializes in the digestive tract. […] NYU Langone gastroenterologists use the newest and most effective diagnostic tools to determine the cause and severity of GERD. Our gastroenterologists can sometimes diagnose GERD based on your symptoms alone, but they also often perform one or more of the following diagnostic tests.

• #1 Diagnosis and treatment of gastroesophageal reflux disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4133436/

  A well-taken history alone can prove very valuable in the diagnosis, especially in the setting of heartburn and acid regurgitation which have a very high specificity (89% and 95%, respectively), albeit low sensitivity (38% and 6%) for GERD. […] Additional testing may be necessary, however, for those who do not respond to acid suppression, those who have alarm symptoms (e.g., dysphagia, odynophagia, iron deficiency anemia, weight loss, etc.) and those who have suffered from the disease for an extended period of time due to concern for Barretts esophagus. […] Ambulatory reflux monitoring is the only modality allowing direct measurement of esophageal acid exposure, reflux episode frequency and association between symptoms and reflux episodes. […] Upper endoscopy is the primary modality used in the evaluation of the esophageal mucosa in patients with GERD and also allows for biopsies of concerning lesions (e.g., Barretts metaplasia, strictures or masses).

• #1 Gastroesophageal reflux disease (GERD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

  During an upper endoscopy, a healthcare professional inserts a thin, flexible tube equipped with a light and camera down the throat and into the esophagus. The tiny camera provides a view of the esophagus, stomach and the beginning of the small intestine, called the duodenum. […] A healthcare professional might be able to diagnose GERD based on a history of symptoms and a physical examination. […] To confirm a diagnosis of GERD, or to check for complications, a care professional might recommend: […] An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine the upper digestive system. The camera helps provide a view of the inside of the esophagus and stomach. Test results may not show when reflux is present, but an endoscopy may find inflammation of the esophagus or other complications.

• #1 Modern diagnosis of GERD: the Lyon Consensus | Gut

  https://gut.bmj.com/content/67/7/1351

  Likewise, questionnaires such as the reflux disease questionnaire (RDQ) and gastroesophageal reflux disease questionnaire (GERDQ) have similar limitations when compared with physiological testing. […] However, in clinical practice, diagnosing and treating GERD based on typical symptoms is pragmatic and endorsed by societal guidelines, even though these symptoms are neither sensitive nor specific for objectively defined GERD. […] Although pragmatic, symptomatic response to PPI therapy does not equate to a GERD diagnosis, exhibiting an imperfect correspondence with objectively defined disease. […] Hence, when evaluated as a diagnostic test for GERD among patients with heartburn, an empiric PPI trial has a sensitivity of 71% and specificity of only 44% compared with the combination of endoscopy and pH-metry.

• #1 Diagnosis and treatment of gastroesophageal reflux disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4133436/

  An upper endoscopy is not required for the diagnosis and is mostly performed for evaluation of GERD associated complications and alternative diagnoses as well as for placement of wireless capsule pH probes. […] Esophageal manometry is most useful for the evaluation of dysmotility and has only limited utility in the evaluation of GERD. […] Surgical therapy is another treatment option for long-term therapy in patients with GERD and has become more appealing since the introduction of laparoscopic anti-reflux surgery.

• #1 Diagnosing Gastroesophageal Reflux Disease | NYU Langone Health

  https://nyulangone.org/conditions/gastroesophageal-reflux-disease/diagnosis

  These tests also allow your doctor to take a close look at the lining of the esophagus for signs of damage that may indicate esophagitis or Barretts esophagus. […] An upper endoscopy is also used to confirm the presence of a hiatal hernia. […] During an impedance-pH test, your gastroenterologist measures the pH, or acidity, levels in your esophagus during a 24-hour period. […] The Bravo pH monitoring system allows your doctor to measure the pH, or acidity, levels in your esophagus for 48 to 96 hours. […] After the test period, you return to your doctor’s office, where he or she uploads the information from the data recorder to a computer and analyzes it. […] Manometry testing assesses the pressure in and movement of the esophagus, so that doctors can determine how well food and liquids move from the mouth to the stomach and whether problems with muscles or nerves in the esophagus may be the cause of GERD.

• #1 Gastroesophageal reflux disease (GERD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

  A monitor is placed in the esophagus to identify when, and for how long, stomach acid regurgitates there. […] X-rays are taken after drinking a chalky liquid that coats and fills the inside lining of the digestive tract. […] This test measures the rhythmic muscle contractions in the esophagus while swallowing. […] This test is done to look for any damage in the esophagus.

• #1 Advances in the physiological assessment and diagnosis of GERD | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2017.130

  The GERD phenotype with the strongest evidence consists of pathological AET associated with positive symptom-reflux association, especially if both SAP and symptom index are positive. […] Monitoring using pH impedance is also used in proven GERD if symptoms persist, when testing is performed on maximal antisecretory therapy. […] The use of impedance planimetry to measure cross-sectional area and distensibility at the EGJ (endoluminal functional lumen imaging probe or endo-FLIP) has shown no demonstrable value in the diagnostic work-up of GERD. […] The use of barium radiography in diagnosing GERD is not recommended. […] Thus, barium radiography alone cannot be used to diagnose GERD, although radiography can be accurate and useful in defining EGJ anatomy. […] The diagnosis of achalasia and EGJ outflow obstruction have profound clinical importance, as invasive management for these conditions (EGJ disruption) is contradictory to that performed in GERD (EGJ enhancement with ARS).

• #1 GERD Testing and Diagnosis

  https://www.healthline.com/health/gerd/gerd-test

  GERD, or gastroesophageal reflux disease, is a digestive disorder in which you experience frequent bouts of acid reflux. Your doctor can use a GERD test to determine if you have this condition. […] There are different types of tests used to diagnose GERD. The best option depends on your symptoms and how severe your symptoms are. […] The main diagnostic GERD tests include: […] Because of this, your doctor may want to check the lining of these areas using an esophagogastroduodenoscopy (EGD). This is the most common GERD test. […] If you have GERD symptoms but have a normal endoscopy, your doctor might recommend ambulatory pH monitoring. This is the most accurate GERD test, making it the gold standard for GERD diagnosis. […] An esophageal impedance pH study is similar to ambulatory pH monitoring.

• #1 Modern diagnosis of GERD: the Lyon Consensus | Gut

  https://gut.bmj.com/content/67/7/1351

  Clinical history, questionnaire data and response to antisecretory therapy are insufficient to make a conclusive diagnosis of GERD in isolation, but are of value in determining need for further investigation. […] Conclusive evidence for reflux on oesophageal testing include advanced grade erosive oesophagitis (LA grades C and D), long-segment Barretts mucosa or peptic strictures on endoscopy or distal oesophageal acid exposure time (AET) 6% on ambulatory pH or pH-impedance monitoring. […] A normal endoscopy does not exclude GERD, but provides supportive evidence refuting GERD in conjunction with distal AET 4%and 40reflux episodes on pH-impedance monitoring off proton pump inhibitors. […] Reflux-symptom association on ambulatory reflux monitoring provides supportive evidence for reflux triggered symptoms, and may predict a better treatment outcome when present.

• #1

• #1 Modern diagnosis of GERD: the Lyon Consensus | Gut

  https://gut.bmj.com/content/67/7/1351

  Ambulatory reflux monitoring can provide confirmatory evidence of GERD, in patients with normal endoscopy, atypical symptoms and/or when contemplating ARS. […] Reflux monitoring demonstrates the consequence of GERD pathophysiology, evident as either excessive oesophageal acid exposure time (AET) or reflux episodes, rather than the mechanism by which that occurs. […] Reflux-symptom association uses simple ratios and statistical tests to determine whether reflux episodes co-occur with symptoms, and adds value to ambulatory reflux monitoring. […] Hence, reflux monitoring can confirm or exclude pathological GERD, although not always conclusively. […] The primary outcome of a 24-hour pH-metry study is the AET. […] The Lyon Consensus proposes that testing always be performed off therapy to demonstrate baseline AET in unproven GERD, meaning no (or low-grade) oesophagitis at endoscopy, and no prior positive pH testing.

• #1 GERD (gastroesophageal reflux disease): Diagnosis and tests

  https://www.medicalnewstoday.com/articles/gerd-lab-tests

• #1

  https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx

  Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. […] The management of functional heartburn and other functional upper gastrointestinal (GI) symptoms is beyond the scope of this guideline. Additional detail regarding esophageal physiologic testing is covered in other guidelines. […] The below recommendations for the diagnosis of GERD are also illustrated in Figure 1. […] For patients with classic GERD symptoms of heartburn and regurgitation who have no alarm symptoms, we recommend an 8-week trial of empiric PPIs once daily before a meal (strong recommendation, moderate level of evidence). […] We recommend diagnostic endoscopy, ideally after PPIs are stopped for 24 weeks, in patients whose classic GERD symptoms do not respond adequately to an 8-week empiric trial of PPIs or whose symptoms return when PPIs are discontinued (strong recommendation, low level of evidence). […] In patients for whom the diagnosis of GERD is suspected but not clear, and endoscopy shows no objective evidence of GERD, we recommend reflux monitoring be performed off therapy to establish the diagnosis (strong recommendation, low level of evidence). […] There is no gold standard for the diagnosis of GERD. Thus, the diagnosis is based on a combination of symptom presentation, endoscopic evaluation of esophageal mucosa, reflux monitoring, and response to therapeutic intervention. Heartburn and regurgitation remain the most sensitive and specific symptoms for GERD, although not as reliable as one might believe. […] Most consensus statements and guidelines advocate a trial of therapy with a PPI as a diagnostic test in patients with the typical symptoms of heartburn and regurgitation, with the underlying assumption that a PPI response establishes the diagnosis of GERD. […] Although esophageal biopsies have little value as a diagnostic test for GERD, they are required to establish a diagnosis of EoE.

• #1 Heartburn differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Heartburn_differential_diagnosis

  Heartburn must be differentiated from other diseases that cause chest pain, such as acute coronary syndromes. Heartburn may also be differentiated from other diseases that cause dysphagia such as esophageal cancer, achalasia and eosinophilic esophagitis in high risk individuals. […] While evaluating heartburn and considering gastroesophageal reflux disease (GERD) its most probable diagnosis, there’s a diagnostic approach that must be performed in order to exclude other causes, especially in high risk patients, according the the American Journal of Gastroenterology guidelines. […] Dysphagia, bleeding, anemia, weight loss and recurrent vomiting are considered warning signs and should be investigated with upper endoscopy. Esophageal cancer, and other severe diseases including esophagitis may be considered, the latter especially in HIV patients. […] Heartburn must be differentiated from other diseases such as GERD, gastritis, peptic ulcer, crohn’s disease, gastric adenocarcinoma, and gastrinoma.

• #1 GERD Diagnosis: Diagnosing Gastroesophageal Reflux Disease | Cooper University Health Care

  https://www.cooperhealth.org/services/gastroesophageal-reflux-disease-gerd/diagnosis

  Although gastroesophageal reflux disease (GERD) is a common digestive condition, its proper diagnosis is critical to fully understand your condition, determine its severity, develop an appropriate treatment plan, and take steps to prevent GERD from worsening over time. […] Because some other conditions and diseases have symptoms that are similar to GERD, it is important to confirm that your symptoms are from GERD and not another, potentially more serious, condition. […] The tests and procedures your Cooper specialist may recommend will depend on your specific symptoms, their severity, your medical and family history and how you have previously responded to other treatments. […] These diagnostic tests may include an esophagogastroduodenoscopy (EGD), esophageal manometry, pH testing and imaging studies, among others.

• #1 Acid Reflux/GERD | ACG

  https://gi.org/topics/acid-reflux/

  Patients with longstanding GERD can experience severe complications. Peptic Stricture: This results from chronic acid injury and scarring of the lower esophagus. Patients complain of food sticking in the lower esophagus. Heartburn symptoms may actually lessen as the esophageal opening narrows down, preventing acid reflux. […] Barrett’s Esophagus: A serious complication of chronic GERD is Barrett’s esophagus. In Barrett’s esophagus, the lining of the esophagus changes to resemble the intestine due to chronic acid exposure. Barrett’s esophagus is a recognized risk factor for cancer of the esophagus and needs long-term follow up. […] Ignoring persistent heartburn symptoms can lead to severe consequences. Esophageal disease may be perceived in many forms, with heartburn being the most common. The severity of heartburn is measured by how long a given episode lasts, how often symptoms occur, and/or their intensity.

• #1

  https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx

  Ambulatory reflux monitoring (pH or impedance-pH) allows for assessment of esophageal acid exposure to establish or refute a diagnosis of GERD and for correlating symptoms with reflux episodes using the symptom index (SI) or symptom association probability (SAP). […] The relationship between symptoms and reflux events can be assessed using the SI or SAP. […] It is generally recommended to monitor after PPIs are stopped for 7 days if the diagnosis of GERD is not clear and before antireflux surgery or endoscopic therapy for GERD to document abnormal acid reflux. […] Approximately two-thirds of pregnant women experience heartburn, which can begin in any trimester. […] Despite its frequent occurrence during pregnancy, heartburn usually resolves after delivery. […] A recently approved device for evaluation of GERD uses a catheter-based balloon lined by sensors that measure mucosal impedance during endoscopy. This technique has shown promise for differentiating GERD from EoE and may develop to be a useful adjunct to endoscopy in the diagnosis of GERD.

• #1 Modern diagnosis of GERD: the Lyon Consensus | Gut

  https://gut.bmj.com/content/67/7/1351

  In contrast, the Lyon Consensus proposes that patients with proven GERD (prior LA grade C or D oesophagitis, long segment Barretts oesophagus or prior abnormal pH-metry) be evaluated on double-dose PPI therapy to establish correlation between refractory symptoms and reflux episodes and/or to exclude inadequate acid suppression or poor compliance as the mechanism of persisting symptoms. […] This assessment requires pH-impedance (vs pH) monitoring since most reflux episodes on PPI therapy are weakly acidic (pH 47). […] The Lyon Consensus builds on the Porto Consensus of 2002, providing recommendations for the use and interpretation of reflux testing techniques in 2018 including oesophageal HRM and baseline impedance measurement that were not widely available in 2002. […] The primary indication for reflux testing is in distinguishing among patients with pathological reflux burden, reflux-mediated hypersensitivity and functional syndromes.

• #1 Gastroesophageal Reflux Disease (GERD) (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/gerd.html

  Gastroesophageal reflux disease (GERD) is when someone has reflux more than twice a week. […] Doctors sometimes order these tests to diagnose GERD or rule out other possible problems: […] 24-hour impedance-ph probe study. This is the most accurate way to detect reflux and how often its happening. […] Early diagnosis and treatment can help reduce or even stop uncomfortable GERD symptoms.

• #2 Diagnosis and treatment of gastroesophageal reflux disease

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4133436/

  Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. […] Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. […] In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. […] The diagnosis of GERD is typically made by a combination of clinical symptoms, response to acid suppression, as well as objective testing with upper endoscopy and esophageal pH monitoring. […] The combination of moderate to severe typical symptoms and endoscopic changes (erosive esophagitis or Barretts esophagus) are highly specific (97%) for GERD (confirmed with pH testing).

• #2 Gastroesophageal reflux disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastro-oesophageal-reflux-disease-gord/

  Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet). […] Your GP will usually be able to diagnose GORD based on your symptoms, although they may refer you for some tests. […] Tests can help to confirm the diagnosis of GORD, check for other possible causes of your symptoms and determine whether you may be suitable for surgery. […] If your symptoms dont get better despite trying self-help measures and over-the-counter medicines, your GP may prescribe a PPI. […] Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated with self-help measures and over-the-counter medicines. […] Medications used to treat GORD, such as proton pump inhibitors (PPIs), can help ulcers heal by reducing the amount of acid that leaks into the oesophagus. […] Your doctor may suggest having an endoscopy every few years to check for this.

• #2 Acid Reflux/GERD | ACG

  https://gi.org/topics/acid-reflux/

  Treatment should be designed to eliminate symptoms, heal irritation of the esophagus and prevent the long-term complications of GERD. In most patients outside of significant lifestyle changes such as weight loss, GERD is a chronic disease. As such, long-term maintenance treatment to control symptoms and prevent complications may be necessary. […] The diagnosis of GERD is often made based on physical and history alone. However occasionally direct measurement of the amount of acid/fluid refluxed into the esophagus is necessary to help diagnose and treat GERD. […] Your doctor or gastroenterologist may wish to evaluate your symptoms with additional tests when it is unclear whether your symptoms are caused by acid reflux, or if you suffer from complications of GERD such as dysphagia (difficulty in swallowing), bleeding, choking, or if your symptoms fail to improve with prescription medications.

• #2

  https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx

  Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. […] The management of functional heartburn and other functional upper gastrointestinal (GI) symptoms is beyond the scope of this guideline. Additional detail regarding esophageal physiologic testing is covered in other guidelines. […] The below recommendations for the diagnosis of GERD are also illustrated in Figure 1. […] For patients with classic GERD symptoms of heartburn and regurgitation who have no alarm symptoms, we recommend an 8-week trial of empiric PPIs once daily before a meal (strong recommendation, moderate level of evidence). […] We recommend diagnostic endoscopy, ideally after PPIs are stopped for 24 weeks, in patients whose classic GERD symptoms do not respond adequately to an 8-week empiric trial of PPIs or whose symptoms return when PPIs are discontinued (strong recommendation, low level of evidence). […] In patients for whom the diagnosis of GERD is suspected but not clear, and endoscopy shows no objective evidence of GERD, we recommend reflux monitoring be performed off therapy to establish the diagnosis (strong recommendation, low level of evidence). […] There is no gold standard for the diagnosis of GERD. Thus, the diagnosis is based on a combination of symptom presentation, endoscopic evaluation of esophageal mucosa, reflux monitoring, and response to therapeutic intervention. Heartburn and regurgitation remain the most sensitive and specific symptoms for GERD, although not as reliable as one might believe. […] Most consensus statements and guidelines advocate a trial of therapy with a PPI as a diagnostic test in patients with the typical symptoms of heartburn and regurgitation, with the underlying assumption that a PPI response establishes the diagnosis of GERD. […] Although esophageal biopsies have little value as a diagnostic test for GERD, they are required to establish a diagnosis of EoE.

• #2 Diagnosing Gastroesophageal Reflux Disease | NYU Langone Health

  https://nyulangone.org/conditions/gastroesophageal-reflux-disease/diagnosis

  These tests also allow your doctor to take a close look at the lining of the esophagus for signs of damage that may indicate esophagitis or Barretts esophagus. […] An upper endoscopy is also used to confirm the presence of a hiatal hernia. […] During an impedance-pH test, your gastroenterologist measures the pH, or acidity, levels in your esophagus during a 24-hour period. […] The Bravo pH monitoring system allows your doctor to measure the pH, or acidity, levels in your esophagus for 48 to 96 hours. […] After the test period, you return to your doctor’s office, where he or she uploads the information from the data recorder to a computer and analyzes it. […] Manometry testing assesses the pressure in and movement of the esophagus, so that doctors can determine how well food and liquids move from the mouth to the stomach and whether problems with muscles or nerves in the esophagus may be the cause of GERD.

• #2 Gastroscopy for GERD: A Diagnostic Tool for Acid Reflux Patients

  https://curasia.com/gastroscopy-for-gerd-a-diagnostic-tool-for-acid-reflux-patients/

  Gastroscopy, a diagnostic procedure, plays a crucial role in the evaluation and management of GERD. […] Timely and accurate diagnosis is crucial for effective treatment and preventing the progression of the disease. […] Gastroscopy, also known as an upper endoscopy, is a diagnostic procedure that involves the insertion of a flexible tube with a light and camera (endoscope) through the mouth and into the esophagus, stomach, and the beginning of the small intestine. […] One of the primary objectives of gastroscopy in the context of GERD is to visualize the esophageal lining. […] The grading of erosive esophagitis helps guide treatment decisions and assess the effectiveness of interventions. […] Gastroscopy allows for the identification of Barretts esophagus and the monitoring of any changes in the affected tissue, as it carries an increased risk of developing esophageal cancer.

• #2 Modern diagnosis of GERD: the Lyon Consensus | Gut

  https://gut.bmj.com/content/67/7/1351

  When putative GERD symptoms do not respond to empiric PPI therapy, upper endoscopy (EGD) is advised both to evaluate for GERD complications and to detect potential alternative diagnoses that might redirect therapy. […] High-grade oesophagitis (LA grades C or D), Barretts oesophagus or peptic stricturing are considered confirmatory evidence for GERD. […] However, erosive oesophagitis is found in only 30% of treatment-nave patients with heartburn and in 10%when already taking a PPI. […] Furthermore, most of that is low-grade, and lower grades of oesophagitis, particularly LA grade A, are non-specific, found in 5%7.5% of asymptomatic controls. […] When accurately defined, LA grade B oesophagitis provides adequate evidence for initiation of medical management of GERD, but problems with interobserver variability led an expert panel to conclude that additional pH-metry evidence is requisite prior to pursuing ARS.

• #2 Gastroesophageal Reflux Disease (GERD)

  https://www.uvmhealth.org/medcenter/conditions-and-treatments/gastroesophageal-reflux-disease-gerd

  Barium X-ray – involves drinking a chalky liquid that causes the upper digestive tract to show up in an X-ray image […] Endoscopy – the doctor inserts a thin tube down the throat. The tube has a light and camera on the end of it so that the doctor can see the esophagus and take tissue samples if necessary.

• #2 Diagnosing Gastroesophageal Reflux Disease | NYU Langone Health

  https://nyulangone.org/conditions/gastroesophageal-reflux-disease/diagnosis

  A barium swallow test, also called an upper GI series, is an X-ray test to examine the upper digestive tract. […] Using the results of diagnostic tests, NYU Langone doctors determine the best course of treatment, with the goal of reducing reflux, alleviating discomfort, healing irritation of the esophagus, and preventing progression to a more serious condition, such as Barretts esophagus.

• #2 Heartburn, Acid Reflux & GERD

  https://digestivediseasescenter.com/condition/heartburn-acid-reflux-gerd

  If you feel a burning sensation in your throat or you have chest pains after eating, acid reflux could be the culprit. Acid reflux occurs when stomach acid backs up into your esophagus. This may cause heartburn and may ultimately cause damage to the lining of the esophagus. […] If you are experiencing chest pain that comes and goes on a regular basis, its time to schedule an appointment with a board-certified gastroenterologist. […] When acid reflux becomes chronic, your doctor can perform various procedures and tests to diagnose GERD and help you develop the appropriate care approach. […] Barium esophagram An X-ray of your upper digestive system. The procedure requires drinking a chalky liquid that coats and fills the inside lining of your digestive tract. This allows the doctor to see the shape and condition of your esophagus, stomach and upper intestine.

• #2 Modern diagnosis of GERD: the Lyon Consensus | Gut

  https://gut.bmj.com/content/67/7/1351

  Ambulatory reflux monitoring can provide confirmatory evidence of GERD, in patients with normal endoscopy, atypical symptoms and/or when contemplating ARS. […] Reflux monitoring demonstrates the consequence of GERD pathophysiology, evident as either excessive oesophageal acid exposure time (AET) or reflux episodes, rather than the mechanism by which that occurs. […] Reflux-symptom association uses simple ratios and statistical tests to determine whether reflux episodes co-occur with symptoms, and adds value to ambulatory reflux monitoring. […] Hence, reflux monitoring can confirm or exclude pathological GERD, although not always conclusively. […] The primary outcome of a 24-hour pH-metry study is the AET. […] The Lyon Consensus proposes that testing always be performed off therapy to demonstrate baseline AET in unproven GERD, meaning no (or low-grade) oesophagitis at endoscopy, and no prior positive pH testing.

• #2 Heartburn: What It Feels Like, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/9617-heartburn-overview

  Esophageal pH test. This test involves implanting a wireless capsule into your esophagus, which detects the pH (acid levels) in your esophagus over time. It may be implanted during an upper endoscopy or through a nasogastric tube. It transmits readings to a receiver you wear on your waistband. You’ll also record your symptoms and the times they occur in a journal to compare with the readings. After a designated period, your healthcare provider will retrieve the capsule and collect the data.

• #2 Refractory Gastroesophageal Reflux Disease: Diagnosis and Management

  https://www.jnmjournal.org/view.html?uid=1890&vmd=Full

  The primary metric assessed from reflux monitoring studies is acid exposure time (AET), the percent time distal esophageal pH is 4.0 over the course of each day for wireless pH studies, or for the extent of the study for catheter based pH and pH-impedance studies. […] Suboptimal symptom control in patients with proven GERD despite optimized antisecretory therapy warrants further investigation aimed at determining whether refractory GERD symptoms are secondary to inadequate reflux control versus alternate non-GERD esophageal and/or non-esophageal disorders. […] Reflux evaluation using pH-impedance monitoring while on optimized PPI therapy is the mainstay in diagnostic assessment when endoscopy is unrevealing, regardless of how GERD was initially confirmed. […] In patients with objective evidence of refractory GERD and persistent symptoms despite optimization of medical therapy, invasive surgical, or endoscopic anti-reflux interventions are options.

• #2 Gastroesophageal Reflux Disease (GERD)/Heartburn | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/g/gastroesophageal-reflux-disease-gerdheartburn.html

  Esophageal manometry. This test checks the pressure inside the esophagus, and evaluates for normal muscle contractions (peristalsis) that are required to push food downward through the intestine. […] pH monitoring. This test checks the pH (acid level) in your esophagus. […] Impedance testing. This test is able to see reflux of acid, plus nonacid liquid and air. It can be done with pH monitoring. […] There are several tests that can be done to see if you have GERD.

• #2

  https://journals.lww.com/ajg/fulltext/2022/01000/acg_clinical_guideline_for_the_diagnosis_and.14.aspx

  Ambulatory reflux monitoring (pH or impedance-pH) allows for assessment of esophageal acid exposure to establish or refute a diagnosis of GERD and for correlating symptoms with reflux episodes using the symptom index (SI) or symptom association probability (SAP). […] The relationship between symptoms and reflux events can be assessed using the SI or SAP. […] It is generally recommended to monitor after PPIs are stopped for 7 days if the diagnosis of GERD is not clear and before antireflux surgery or endoscopic therapy for GERD to document abnormal acid reflux. […] Approximately two-thirds of pregnant women experience heartburn, which can begin in any trimester. […] Despite its frequent occurrence during pregnancy, heartburn usually resolves after delivery. […] A recently approved device for evaluation of GERD uses a catheter-based balloon lined by sensors that measure mucosal impedance during endoscopy. This technique has shown promise for differentiating GERD from EoE and may develop to be a useful adjunct to endoscopy in the diagnosis of GERD.

• #2 Patient education: Gastroesophageal reflux disease in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/gastroesophageal-reflux-disease-in-adults-beyond-the-basics

  An upper endoscopy is a test that allows a doctor to directly examine the upper gastrointestinal (GI) tract. […] An esophageal pH study is the most direct way to measure the severity of acid reflux. […] Esophageal manometry involves having a tube placed through your nose into your esophagus that measures the pressure from the muscle contractions (esophageal peristalsis).

• #2 Acid Reflux Testing – Houston Heartburn Center

  https://houstonheartburn.com/diagnostics-of-gerd/

  GERD cannot be accurately diagnosed based upon symptoms only. […] At Houston Heartburn and reflux Center, we adopt a comprehensive evaluation using state of the art diagnostic testing. […] The following are the most commonly used studies: […] Upper Endoscopy: also called EGD […] A specialist examines these samples under a microscope to check for inflammation or other changes resulting from acid reflux. […] Ambulatory pH Monitoring […] This is the most accurate and objective test for diagnosing GERD. […] Esophageal Manometry […] Manometry is required if the Nissen Fundoplication is considered as a treatment option. […] Barium Swallow: also called upper GI series […] Gastric Emptying Study […] Patients with delayed gastric emptying (gastroparesis) may suffer from acid reflux. […] Our absolute commitment is to be there for you in your fight against acid reflux.

• #2 Modern diagnosis of GERD: the Lyon Consensus | Gut

  https://gut.bmj.com/content/67/7/1351

  The primary focus of oesophageal testing has hitherto been restricted to detection of excessive acid reflux as indicative of pathological GERD, supported by reflux-symptom association analysis. […] The association of oesophageal acid exposure with patient symptoms is weak, making sole reliance of this metric problematic. […] Expansion of testing to include oesophageal mucosal impedance, manometry, histopathology and psychometrics may help in this regard, potentially identifying distinct GERD phenotypes with unique management implications. […] Each test adds a piece to the overall puzzle of symptom generation, disease pathophysiology and precision management. […] GERD is empirically diagnosed and treated in clinical practice based on the clinicians symptom assessment. […] Indications for testing include treatment failure, diagnostic uncertainty and treating (or preventing) complications of GERD.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/How-is-Acid-Reflux-Diagnosed.aspx

  Heartburn is a symptom that is often indicative of an underlying condition of acid reflux or Gastro-esophageal reflux disorder. Diagnosis of heartburn is vital as its symptoms are similar to that of a heart attack or other chest pathologies. […] Diagnosis of heartburn or acid reflux disorder includes the following. […] Medical history involves taking a detailed assessment of the condition in the past of its presence in the family. […] Physical examination looks for features like anemia, weight loss and malnutrition due to difficulty in swallowing. […] Heartburn may also be caused by heart attacks, rib injury, esophagitis due to swallowed corrosives or drugs like NSAIDS, peptic ulcer, infections in HIV positive and other immune-suppressed patients due to herpes, candida, cytomegalovirus, etc. These need to be ruled out.

• #2 Acid Reflux/GERD | ACG

  https://gi.org/topics/acid-reflux/

  Patients with longstanding GERD can experience severe complications. Peptic Stricture: This results from chronic acid injury and scarring of the lower esophagus. Patients complain of food sticking in the lower esophagus. Heartburn symptoms may actually lessen as the esophageal opening narrows down, preventing acid reflux. […] Barrett’s Esophagus: A serious complication of chronic GERD is Barrett’s esophagus. In Barrett’s esophagus, the lining of the esophagus changes to resemble the intestine due to chronic acid exposure. Barrett’s esophagus is a recognized risk factor for cancer of the esophagus and needs long-term follow up. […] Ignoring persistent heartburn symptoms can lead to severe consequences. Esophageal disease may be perceived in many forms, with heartburn being the most common. The severity of heartburn is measured by how long a given episode lasts, how often symptoms occur, and/or their intensity.

• #2 Gastroesophageal reflux disease and heartburn Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/report/gastroesophageal-reflux-disease-and-heartburn

  Gastroesophageal reflux disease (GERD) is a condition in which gastric contents and acid flow up from the stomach into the esophagus (food pipe) due to poor stomach emptying, poor valve function, and problems with the esophagus. […] Early diagnosis and treatment is best in order to avoid complications such as changes in the esophagus that can lead to cancer. […] A combination of tests is often needed to confirm the diagnosis. […] Upper endoscopy is recommended for people with severe GERD symptoms, for adults who have had an unsuccessful trial of proton pump inhibitors (PPIs) for GERD, and for men over 50 with chronic GERD symptoms and other risk factors. […] Certain people will require ongoing monitoring and examinations every 3 to 5 years or sooner. […] A physician can usually diagnose GERD if the person finds relief from persistent heartburn and acid regurgitation after taking antacids for short periods of time.

• #2 Advances in the physiological assessment and diagnosis of GERD | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2017.130

  The GERD phenotype with the strongest evidence consists of pathological AET associated with positive symptom-reflux association, especially if both SAP and symptom index are positive. […] Monitoring using pH impedance is also used in proven GERD if symptoms persist, when testing is performed on maximal antisecretory therapy. […] The use of impedance planimetry to measure cross-sectional area and distensibility at the EGJ (endoluminal functional lumen imaging probe or endo-FLIP) has shown no demonstrable value in the diagnostic work-up of GERD. […] The use of barium radiography in diagnosing GERD is not recommended. […] Thus, barium radiography alone cannot be used to diagnose GERD, although radiography can be accurate and useful in defining EGJ anatomy. […] The diagnosis of achalasia and EGJ outflow obstruction have profound clinical importance, as invasive management for these conditions (EGJ disruption) is contradictory to that performed in GERD (EGJ enhancement with ARS).

• #2 Diagnosis and management of extraesophageal gastroesophageal reflux disease (GERD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-extraesophageal-gastroesophageal-reflux-disease-gerd/

  6. In patients with suspected extraesophageal manifestation of GERD who have failed one trial (up to 12 weeks) of PPI therapy, one should consider objective testing for pathologic GER, because additional trials of different PPIs are low yield. […] 7. Initial testing to evaluate for reflux should be tailored to patients’ clinical presentation and can include upper endoscopy and ambulatory reflux monitoring studies of acid suppressive therapy. […] 8. Testing can be considered for those with an established objective diagnosis of GERD who do not respond to high doses of acid suppression. Testing can include pH-impedance monitoring while on acid suppression to evaluate the role of ongoing acid or non-acid reflux. […] 9. Alternative treatment methods to acid suppressive therapy (e.g., lifestyle modifications, alginate-containing antacids, external upper esophageal sphincter compression device, cognitive-behavioral therapy, neuromodulators) may serve a role in management of EER symptoms.

• #2 Diagnosis and management of extraesophageal gastroesophageal reflux disease (GERD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/diagnosis-and-management-of-extraesophageal-gastroesophageal-reflux-disease-gerd/

  Experts provide 10 new best practices for diagnosing and managing your patients with extraesophageal GERD. […] 1. Gastroenterologists should be aware of potential extraesophageal manifestations of gastroesophageal reflux disease (GERD) and should inquire about such disorders including laryngitis, chronic cough, asthma and dental erosions in GERD patients to determine whether GERD may be a contributing factor to these conditions. […] 2. Development of a multidisciplinary approach to extraesophageal (EER) manifestations is an important consideration because the conditions are often multifactorial, requiring input from non-gastroenterology specialties. Results from diagnostic testing (i.e., bronchoscopy, thoracic imaging, laryngoscopy, etc.) from non-GI disciplines should be taken into consideration when gastroesophageal reflux (GER) is considered as a cause for extraesophageal symptoms.

• #2 Acid Reflux/GERD | ACG

  https://gi.org/topics/acid-reflux/

  If you are experiencing heartburn two or more times a week, you may have acid reflux disease, also known as GERD, which, if left untreated, is potentially serious. […] If you are self-medicating for heartburn two or more times a week, or if you still have symptoms on your over-the-counter or prescription medication, you need to see a doctor and perhaps be referred to a gastroenterologist.

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