As to whether there is any definitive test to diagnose reflux disease, the gold standard for diagnosing reflux is a 24-hour pH monitor. The reason for that is that while an upper endoscopy can show the presence of esophagitis (inflammation of the esophagus); most patients with symptoms of reflux do not have esophagitis on endoscopy. That is because in a majority of patients, when acid refluxes up into the esophagus from the stomach, it causes symptoms, but when the acid returns back to the stomach it does not cause any damage (or esophagitis).
That being said, an endoscopy is the only way to rule out Barrett's esophagus, which is a pre-cancerous condition of the esophagus that can only be diagnosed by biopsy. While most patients with symptoms of reflux have improvement in symptoms with acid-lowering drugs, those that don't may not have reflux at all.
In those patients, the gold standard to diagnose reflux is with a 24 hour pH monitor. The reason why that test is not commonly done however is because most patients are not accepting of the idea of having a probe placed into their esophagus that protrudes through the nostril for 24 hours. The test is also not readily available. If, however, you are experiencing symptoms of reflux that is not responding to acid lowering agents, your doctor might consider it.
Published On: October 22, 2007