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Heartburn / GERD

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Screening and diagnosis

Usually a description of your symptoms will be all your doctor needs to establish the diagnosis of heartburn. However, if your symptoms are particularly severe or don't respond to treatment, you may need to undergo other tests:

  • Barium X-ray. This procedure requires you to drink a chalky liquid that coats and fills the hollows of your digestive tract. The coating allows your doctor to get a clear silhouette of the shape and condition of your esophagus, stomach and upper intestine (duodenum). X-rays can then reveal whether a hiatal hernia may be contributing to your heartburn. They can also reveal an esophageal narrowing or stricture, or a growth, which may cause difficulty swallowing.

  • Endoscopy. A more direct test for diagnosing the cause of heartburn is esophagogastroduodenoscopy (EGD). In this test your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. The endoscope allows your doctor to see if you have an ulcerated or inflamed esophagus or stomach (esophagitis or gastritis, respectively). It can also reveal a peptic ulcer. During an EGD your doctor can take tissue samples to test for Barrett's esophagus — a condition in which precancerous changes occur in cells in your esophagus — or esophageal cancer, two potential complications of severe heartburn. Analysis of these samples may also reveal the presence of a bacterium that may cause peptic ulcers.

  • Ambulatory acid (pH) probe test. This test measures acid levels in your upper and lower esophagus, and can help determine the frequency and duration of acid reflux. While you're sitting, a nurse or technician sprays your throat with a numbing medication. Then a thin, flexible tube (catheter) is threaded through your nose into your esophagus. This probe is positioned just above the lower esophageal sphincter. A second probe may be placed in your upper esophagus. Attached to the other end of the catheter is a small computer, which you wear around your waist and which records acid measurements. Once the device is attached, you go about your business and then come back the next day to have the device removed. Knowing the frequency and duration of acid reflux can help your doctor determine how best to treat the condition.


In addition to irritation and inflammation of your esophagus (esophagitis), chronic reflux of stomach acid into your esophagus can lead to one or more of the following conditions if left untreated:

  • Esophageal narrowing (stricture). Strictures occur in some people with GERD. Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing large chunks of food to get caught up in the narrowing, and can interfere with swallowing.

  • Esophageal ulcer. Stomach acid can severely erode tissues in the esophagus, causing an open sore. The esophageal ulcer may bleed, cause pain and make swallowing difficult.

  • Barrett's esophagus. This is a serious, though uncommon, complication of GERD. In Barrett's esophagus, the color and composition of the tissue lining the lower esophagus change. Instead of pink, the tissue turns a salmon color. Under a microscope, the tissue resembles that of the small intestine. This cellular change is called metaplasia. Metaplasia is brought on by repeated and long-term exposure to stomach acid and is associated with an increased risk of esophageal cancer.

Heartburn/GERD > 1 > 2 > 3 > 4

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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Last Modified : 03/15/08 12:51 AM