Gastroesophageal Reflux Disease (GERD)

Diagnosis

Your doctor will ask you to estimate how often you have heartburn or other symptoms of GERD, whether your symptoms are worse when you lie down or bend over and whether they are relieved by over-the-counter heartburn remedies. Your doctor also will review your current medications, because some medications can loosen the esophageal sphincter. These include the asthma medicines theophylline or albuterol (both sold under several brand names), blood pressure or heart medications such as calcium channel blockers and different forms of nitroglycerin, muscle relaxants, anxiety medicines, medicines for an overactive bladder, migraine medicines and medicines to treat diarrhea. Medicines that reduce the amount of saliva you produce cause your esophagus to be rinsed less frequently, so they also cause symptoms of GERD to be worse. Antihistamines and many antidepressants can have this effect.

Pain that feels like heartburn also can be a symptom of coronary artery disease, so your doctor may ask whether you have any symptoms of heart problems, including shortness of breath, palpitations and dizziness. Your doctor may test for heart problems.

If your only complaint is mild heartburn and your physical examination is normal, then your doctor may suggest that you try lifestyle changes and over-the-counter medications before beginning any special diagnostic testing or prescription treatment.

If you have more serious symptoms - such as severe long-lasting heartburn, difficulty swallowing or weight loss, - or if your heartburn is not relieved by medications, then you will need further testing. The best test is for a doctor to look directly at your esophagus with an instrument called an endoscope. This test is called endoscopy (or esophogogastroduodenoscopy, “EGD”), and it usually is done by a gastroenterology specialist. If necessary, during endoscopy, your doctor can take a small sample of tissue (biopsy) to be examined in a laboratory. To check for other possible causes of your symptoms, your doctor also may look at your stomach and first part of the small intestines by using the endoscope. You also may have one or more of the following tests: