Materiały źródłowe

• #1 Heartburn – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heartburn/diagnosis-treatment/drc-20373229

  To determine if your heartburn is a symptom of gastroesophageal reflux disease (GERD), your doctor may recommend: […] X-ray, to view the shape and condition of your esophagus and stomach. […] Endoscopy, to view your esophagus with a tiny camera to check for irregularities. A tissue sample (biopsy) may be taken for analysis. […] Ambulatory acid probe tests, to identify when, and for how long, stomach acid backs up into your esophagus. An acid monitor that is placed in your esophagus connects to a small computer that you wear around your waist or on a strap over your shoulder. […] Esophageal motility testing, to measure movement and pressure in your esophagus. […] An upper gastrointestinal endoscopy involves inserting a flexible, lighted tube called an endoscope down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine, called the duodenum.

• #1 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 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). […] 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.

• #1 Heartburn – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heartburn/diagnosis-treatment/drc-20373229

  If nonprescription treatments don’t work or you rely on them often, see your health care provider. You may need prescription medication and further testing. […] You may be referred to a doctor who specializes in disorders of the digestive system (gastroenterologist). […] What kinds of tests do I need? Do these tests require any special preparation? […] What treatments are available? […] Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked: […] What, if anything, seems to improve or worsen your symptoms? Are they worse after meals or lying down? […] What you can do in the meantime: Try lifestyle changes to control your symptoms until you see your doctor. For instance, avoid foods that trigger your heartburn and avoid eating at least two hours before bedtime.

• #1 Gastroesophageal Reflux Disease: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0301/p1161.html

  Gastroesophageal reflux disease (GERD) can usually be diagnosed based on the clinical presentation alone. […] The symptoms of gastroesophageal reflux disease (GERD) vary from patient to patient, and multiple diagnostic tests and treatments are available. […] When patients present with typical symptoms and no complications, the diagnosis of GERD is usually straightforward. The classic symptoms are heartburn and regurgitation, which may also include dysphagia. […] In the absence of classic symptoms, GERD becomes more difficult to diagnose. […] A recent study demonstrated a potential role for a proton pump inhibitor, omeprazole (Prilosec), in the diagnosis of GERD. The response of symptoms to omeprazole, in a dosage of 40 mg per day for 14 days, was shown to be about as specific and sensitive for the diagnosis of GERD as the results of 24-hour pH monitoring. […] Endoscopy is useful for diagnosing the complications of GERD, such as Barrett’s esophagus, esophagitis and strictures, but it is not sensitive for diagnosis of GERD itself. […] Ambulatory pH monitoring is generally considered the diagnostic gold standard for use in patients with GERD.

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

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

  However, when compared with objective evidence of GERD defined by pH-metry or endoscopy, even an expert history by a gastroenterologist has only 70% sensitivity and 67% specificity, reiterating the distinction between a physiology-based and a symptom-based GERD diagnosis. […] Although pragmatic, symptomatic response to PPI therapy does not equate to a GERD diagnosis, exhibiting an imperfect correspondence with objectively defined disease. […] On average, 69% of patients with oesophagitis, 49% of patients with non-erosive reflux disease (NERD) and 35% of patients with normal endoscopy and pH-metry gain symptom relief from a PPI trial. […] 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 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 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. […] An endoscopy also can be used to collect a sample of tissue, called a biopsy, to be tested for complications such as Barrett esophagus. […] 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. […] Esophageal manometry also measures the coordination and force exerted by the muscles of the esophagus.

• #1 Diagnosis and treatment of gastroesophageal reflux disease

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

  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). […] The short and medium term outcomes of laparoscopic anti-reflux surgery are quite good in terms of improving the typical symptoms of GERD. […] However, in the long term it appears these results may diminish.

• #1 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.

• #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 various types of tests used to diagnose GERD. The best option depends on your symptoms. […] 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. […] An esophageal manometry checks the strength of your esophageal muscles.

• #1 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. […] Typical GERD symptoms (heartburn and acid regurgitation) are more likely than atypical symptoms to respond to treatment, emphasising the value of an accurate clinical history.

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

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

  Gastroesophageal reflux disease (GERD) occurs when the stomach contents back up into the esophagus and/or mouth. […] By contrast, people with gastroesophageal reflux disease (GERD) experience bothersome symptoms or damage to the esophagus as a result of acid reflux. […] This article discusses the symptoms, causes, diagnosis, and treatment of GERD in adults. […] The diagnosis of GERD is based on your symptoms as well as other risk factors. […] If you have the „classic” symptoms of GERD (heartburn and/or regurgitation) your health care provider may be able to diagnose you with GERD based on this alone. […] Your provider might recommend additional evaluation and testing if you: […] 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).

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

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

  Testing off therapy is also recommended when done to evaluate for ARS. […] 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.

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

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

  When the diagnosis is inconclusive on reflux monitoring alone, the use of additional features are suggested, including histology, new pH-impedance metrics and high-resolution manometry. […] A new classification of oesophageal contractility and oesophagogastric junction motor findings in GERD is made, incorporating data obtained by high-resolution manometry. […] The pathophysiology of GERD does not have a direct implication on initial GERD management, as treatment consists of acid suppression. […] However, if GERD symptoms persist despite empiric therapy and endoscopy is normal, further oesophageal testing is recommended. […] Most metrics (LES basal pressure, integrated relaxation pressure, distal contractile integral, hiatus hernia size) utilized in reporting oesophageal motor function in GERD are readily obtained from oesophageal HRM using a standard protocol of ten 5 ml water swallows in the supine position.

• #1

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

  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. […] Barium radiographs should not be used solely as a diagnostic test for GERD. The presence of reflux on a barium esophagram or upper GI series has poor sensitivity and specificity for GERD when compared with pH testing. […] Upper endoscopy is the most widely used objective test for evaluating the esophageal mucosa. For patients with GERD symptoms who also have alarm symptoms such as dysphagia, weight loss, bleeding, vomiting, and/or anemia, endoscopy should be performed as soon as feasible.

• #1 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.

• #1 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/

  3. Currently, there is no single diagnostic tool that can conclusively identify GER as the cause of EER symptoms. Determination of the contribution of GER to EER symptoms should be based on the global clinical impression derived from patients’ symptoms, response to GER therapy, and results of endoscopy and reflux testing. […] 4. Consideration should be given toward diagnostic testing for reflux before initiation of proton pump inhibitor (PPI) therapy in patients with potential extraesophageal manifestations of GERD, but without typical GERD symptoms. Initial single-dose PPI trial, titrating up to twice daily in those with typical GERD symptoms, is reasonable. […] 5. Symptom improvement of EER manifestations while on PPI therapy may result from mechanisms of action other than acid suppression and should not be regarded as confirmation for GERD.

• #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. It’s a more serious condition than GER. Doctors usually treat it with medicine. […] Tell your parents and visit your doctor if you’ve had heartburn that doesn’t seem to go away or any other symptoms of GERD for a while. […] 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. A thin, flexible tube goes through the nose into the esophagus. The tip rests just above the esophageal sphincter for 24 hours to check acid levels in the esophagus and to detect any reflux. […] Early diagnosis and treatment can help reduce or even stop uncomfortable GERD symptoms. Untreated GERD can cause permanent damage to the esophagus.

• #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. […] 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). […] We recommend against performing reflux monitoring off therapy solely as a diagnostic test for GERD in patients known to have endoscopic evidence of Los Angeles (LA) grade C or D reflux esophagitis or in patients with long-segment Barrett’s esophagus (strong recommendation, low level of evidence).

• #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 in high risk individuals. […] Cardiac causes must be excluded since they can be life-threatening and may present with similar symptoms. […] 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. […] Heartburn must be differentiated from other diseases such as GERD, gastritis, peptic ulcer, crohn’s disease, gastric adenocarcinoma, and gastrinoma.

• #1 Acid Reflux/GERD | ACG

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

  GERD is caused by the flow of gastric acid and bile into the esophagus. The stomach is designed to handle these fluids. When the gastric contents come into contact with the esophagus, it can produce the classic symptoms of heartburn and regurgitation. In addition, these fluids are toxic to the lining of the esophagus and can cause damage such as ulcers or even pre-cancerous changes such as Barrett’s esophagus. […] GERD can result in serious complications including severe chest pain that can mimic a heart attack, esophageal stricture (a narrowing or obstruction of the esophagus), bleeding, or a pre-cancerous change in the lining of the esophagus called Barrett’s esophagus. […] 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.

• #1 Acid Reflux/GERD | ACG

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

  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. […] 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.

• #1

  https://medcline.com/blogs/acid-reflux/gerd-test

  If a patient is experiencing acid reflux thats causing damage to their esophageal lining, they have GERD. […] If youre experiencing acid reflux but its not causing damage to your esophageal lining, your doctor may diagnose you with non-erosive GERD. […] An esophagram is an X-ray thats taken of your esophagus using barium to help doctors get a look inside your esophagus. […] If you think you may have GERD, the best thing you can do is get a diagnosis from a doctor as early as possible. […] The sooner you get a diagnosis, the sooner you can talk to your doctor about treatment options.

• #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. […] Physical examination looks for features like anemia, weight loss and malnutrition due to difficulty in swallowing. Reflux of acid may also result in complications of lungs like lung abscess, pneumonia and interstitial pulmonary fibrosis. […] 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 Clinical manifestations and diagnosis of gastroesophageal reflux in adults – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-gastroesophageal-reflux-in-adults

  Clinical manifestations and diagnosis of gastroesophageal reflux in adults […] This topic will review the clinical manifestations and diagnosis of GERD. […] We classify gastroesophageal reflux disease (GERD) based either on the appearance of the esophageal mucosa on upper endoscopy or the correlation between pH-metry results and patient-reported symptoms. […] Erosive esophagitis – Erosive esophagitis is the unequivocal finding of GERD. […] True nonerosive reflux disease (NERD) – True NERD is defined by quantifiably excessive esophageal acid exposure based on testing with pH-metry in the absence of erosive esophagitis.

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

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

  However, when compared with objective evidence of GERD defined by pH-metry or endoscopy, even an expert history by a gastroenterologist has only 70% sensitivity and 67% specificity, reiterating the distinction between a physiology-based and a symptom-based GERD diagnosis. […] Although pragmatic, symptomatic response to PPI therapy does not equate to a GERD diagnosis, exhibiting an imperfect correspondence with objectively defined disease. […] On average, 69% of patients with oesophagitis, 49% of patients with non-erosive reflux disease (NERD) and 35% of patients with normal endoscopy and pH-metry gain symptom relief from a PPI trial. […] 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.

• #2 Heartburn – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/heartburn/diagnosis-treatment/drc-20373229

  To determine if your heartburn is a symptom of gastroesophageal reflux disease (GERD), your doctor may recommend: […] X-ray, to view the shape and condition of your esophagus and stomach. […] Endoscopy, to view your esophagus with a tiny camera to check for irregularities. A tissue sample (biopsy) may be taken for analysis. […] Ambulatory acid probe tests, to identify when, and for how long, stomach acid backs up into your esophagus. An acid monitor that is placed in your esophagus connects to a small computer that you wear around your waist or on a strap over your shoulder. […] Esophageal motility testing, to measure movement and pressure in your esophagus. […] An upper gastrointestinal endoscopy involves inserting a flexible, lighted tube called an endoscope down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine, called the duodenum.

• #2 Heartburn: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/primary-care/heartburn/treatment

  How is Heartburn Diagnosed? Diagnosis If your heartburn is severe or lasts for more than two weeks, it may be time to see a doctor. Chronic heartburn can be a sign of a more serious condition, including gastroesophageal reflux disease (GERD) and Barretts esophagus which, left untreated, can damage the esophagus and possibly lead to esophageal cancer. […] To determine the severity of your heartburn, your physician may order the following tests: […] Endoscopy. A doctor guides a thin, flexible tube with a camera on the end down your throat, providing an image of the upper GI tract. […] Esophageal pH monitoring, or ambulatory probe test. An acid monitor is placed into your esophagus and connected to a device worn on a belt or shoulder strap. Over 24 hours, the monitor measures how often the acid backs up into the esophagus.

• #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. […] 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

  https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/gastroesohageal-reflux-gerd

  When acid reflux starts to happen frequently and you have other symptoms, you may have developed gastroesophageal reflux disease (GERD). […] To receive a diagnosis for GERD, you’ll meet with your doctor to talk about your symptoms. Your doctor will also perform a physical exam and may order tests, including: […] A flexible tube equipped with a light and a tiny camera (endoscope) is inserted down the throat to see inside the esophagus and stomach. If needed, a tissue sample (biopsy) can be done during an endoscopy. […] This test checks for stomach acid in the esophagus. […] This measures if the esophagus is working properly. A thin, flexible tube (catheter) is inserted into the nose, down the esophagus and into the stomach. […] If you have gastroesophageal reflux disease, your Aurora team will work with you to determine the best GERD treatment options for relief.

• #2 GERD Diagnostics | Memorial Heartburn Center

  https://www.memorialphysicianpractices.com/gerd-diagnostics

  The Memorial Heartburn Center offers a variety of diagnostic tests to check for GERD, including: […] Esophageal pH monitoring is a minimally invasive test that evaluates whether acid from the stomach is refluxing into the esophagus and causing various symptoms. […] Impedance reflux monitoring measures the amount of reflux (both acidic and non-acidic) in the esophagus during a 24-hour period and assesses whether the patients symptoms are correlated with the reflux. […] An alternative method for monitoring esophageal muscle movement has the patient swallow a barium-soaked marshmallow followed by a barium-soaked bagel portion. […] The patient is asked to perform swallowing maneuvers, providing information on the status of the esophageal muscle function, coordination and contract ability of a patients swallowing mechanism.

• #2 Gastroesophageal Reflux Disease (GERD): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/digestive/esophageal-diseases/gastroesophageal-reflux-disease-gerd/treatment

  Esophageal pH Impedance: A thin tube is placed through your nose into your esophagus to measure the amount of fluid coming into your esophagus from the stomach (reflux) over a 24-hour time period. […] High-resolution esophageal manometry with or without impedance testing measures the pressure, strength, and coordination of the muscles in your esophagus and esophageal sphincter. […] Esophagram: in this test, you are given liquid barium and x-rays are taken to evaluate your swallow as well as your entire esophagus as it empties into your stomach. […] How is GERD Treated? Treatment Treatment for GERD includes dietary and lifestyle changes such as weight loss, not lying down after eating, avoiding eating before bed, smoking cessation, avoiding trigger foods, and/or elevating the head of the bed.

• #2 Heartburn: Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/primary-care/heartburn/treatment

  Esophageal manometry. A catheter is inserted into the esophagus to measure movement and pressure. […] ECG (electrocardiogram). To rule out any heart issues, sensors are applied to the body so the ECG can record the hearts electrical activity. […] A primary care doctor can address your heartburn symptoms, determine a course of treatment, and, if required, refer you to a specialist. They can suggest certain lifestyle/diet changes, recommend over-the-counter drugs, and prescribe medications that help alleviate heartburn symptoms. […] Heartburn is extremely common. Many symptoms can be treated at home or disappear on their own. But severe and reoccurring heartburn symptoms can be a sign of a more serious condition. […] NewYork-Presbyterian houses some of the best primary care physicians in the country. They can diagnose your symptoms, offer heartburn treatment solutions, and refer you to a qualified specialist if necessary.

• #2 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 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. […] An endoscopy also can be used to collect a sample of tissue, called a biopsy, to be tested for complications such as Barrett esophagus. […] 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. […] Esophageal manometry also measures the coordination and force exerted by the muscles of the esophagus.

• #2 GERD: A practical approach | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/4/223

  A meta-analysis showed that a short course of PPI therapy has a 78% sensitivity and 54% specificity in accurately diagnosing GERD. […] In patients with chest pain, a cardiac condition should be ruled out before considering GERD. […] Endoscopic findings in GERD may include erosive esophagitis, strictures, and Barrett esophagus. However, many patients with GERD have normal findings on endoscopy. […] Esophageal pH monitoring is indicated in patients with persistent symptoms and normal findings on endoscopy before surgical or endoscopic interventions are considered. […] Barium esophagography is not indicated in the workup of reflux disease as it has poor sensitivity and specificity for GERD.

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

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

  Evaluation and reporting of oesophageal motor function in GERD can be achieved through three hierarchical steps. […] The first two steps can reveal abnormalities that can be independent of each other; however, the coexistence of abnormalities might predict an increased likelihood of abnormal oesophageal reflux burden. […] Ambulatory reflux monitoring is performed to document oesophageal reflux burden or to define the relationship between symptom events and reflux episodes. […] Typical reflux symptoms (heartburn, acid regurgitation) are initially treated with empiric acid suppression in the absence of alarm symptoms. […] Endoscopy (with oesophageal biopsy sample to evaluate eosinophilic oesophagitis) is performed if alarm symptoms are present, if symptoms do not respond to empiric acid suppression or if presentation is atypical.

• #2 GERD: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/14085

  If lifestyle changes and medications do not significantly improve the symptoms of GERD, a gastroenterologist may recommend surgery. […] GERD can worsen and result in other conditions if left untreated. These may include esophagitis, esophageal stricture, Barrett’s esophagus, and respiratory problems. […] GERD is a treatable condition. A combination of lifestyle changes and medications is often enough to treat it. However, it may cause severe complications if left untreated and could require surgery.

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

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

  Impedance testing. This test is able to see reflux of acid, plus nonacid liquid and air. It can be done with pH monitoring. […] If GERD is not treated, it can lead to other health problems. These may include: […] Esophagitis. This is an inflammation of the esophagus caused by the acid in your stomach contents. This may lead to ulcers and bleeding in the lining of the esophagus. […] Narrowing of the esophagus, also called strictures. This can make it hard to swallow. […] Chronic cough, laryngitis, or breathing problems. This happens when stomach contents from your esophagus go into your lungs. […] Barretts esophagus. This complication of GERD occurs when the cells in the lining of your esophagus change, becoming more like the lining of the small intestine. In some cases, it can lead to esophageal cancer. […] There are several tests that can be done to see if you have GERD. […] Making diet and lifestyle changes can help reduce GERD symptoms. Some medicines may also help reduce symptoms.

• #2 Diagnosis and Management of Gastroesophageal Reflux Disease

  https://www.mdcalc.com/guidelines/500/acg/diagnosis-management-gastroesophageal-reflux-disease

  Establishing diagnosis Empiric PPI is recommended if typical GERD symptoms. […] Diagnostic evaluation is required if non-cardiac chest pain suspicious for GERD. Exclude cardiac causes before evaluating GERD. […] Endoscopy for typical GERD is recommended if alarm symptoms, and for screening if high risk for Barretts esophagus. […] Ambulatory reflux monitoring is indicated before considering endoscopic or surgical therapy if refractory symptoms, or if GERD diagnosis is questionable. […] Esophageal manometry is indicated for preoperative evaluation. […] PPI trial indicated in patients if extraesophageal symptoms and typical GERD symptoms. […] Reflux monitoring should be pursued if extraesophageal symptoms without typical GERD symptoms. […] PPI (8-week course, once daily 30 mins before breakfast) is initial therapy for symptoms and erosive esophagitis.

• #2 GERD Symptoms and Diagnosis

  https://www.everydayhealth.com/gerd/guide/symptoms/

  What are some diagnostic tests for GERD? Diagnostic tests for GERD include an ambulatory acid probe, an upper endoscopy, esophageal manometry (which measures contractions in the esophagus), and an upper GI series of X-rays. These tests help measure acid levels, examine the esophagus for damage, assess muscle contractions, and detect strictures or ulcers.

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