Diagnostic Work-Up of GERD

• Published in: Gastrointestinal endoscopy clinics of North America Vol. 24; no. 4; pp. 655 - 666
• Main Author: Vela, Marcelo F., MD, MSCR
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2014
• Subjects: Electric Impedance; Endoscopy; Esophageal pH Monitoring; Esophagitis, Peptic - diagnosis; Esophagitis, Peptic - pathology; Esophagoscopy; Gastroenterology and Hepatology; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - drug therapy; Gastroesophageal reflux disease (GERD); Heartburn; Humans; Impedance-pH monitoring; pH monitoring; Proton pump inhibitor test; Proton Pump Inhibitors - therapeutic use; Surgery; Proton pump inhibitor test; Endoscopy; Impedance-pH monitoring; pH monitoring; Gastroesophageal reflux disease (GERD); Heartburn
• ISSN: 1052-5157; 1558-1950
• DOI: 10.1016/j.giec.2014.07.002

Gastroesophageal reflux disease (GERD) is frequently diagnosed by symptoms and good response to acid suppression with proton pump inhibitors. Further work up is required when the diagnosis of GERD is uncertain, for alarm symptoms, PPI-refractoriness, and often for extraesophageal presentations. Useful tools include endoscopy for mucosal assessment and reflux monitoring (pH or impedance-pH) to quantify reflux burden. Objective documentation of pathological reflux is mandatory prior to anti-reflux surgery. In some patients, symptoms that can be attributed to GERD may have other causes; in these patients, testing that excludes GERD helps direct the diagnostic and treatment efforts to other causes.