Do you need diagnostic tests for heartburn?
You just enjoyed a delicious meal, but now a burning feeling is creeping up your chest: classic heartburn. Heartburn is a common symptom of gastroesophageal reflux disease (GERD), or acid reflux, which occurs when stomach acid flows back into the esophagus. Sometimes the pain is so intense it mimics a heart attack, leaving you wondering whether something more serious is going on.
Doctors often skip extensive testing for straightforward cases, but certain red flags, such as trouble swallowing, internal bleeding, or severe symptoms that do not respond to treatment, call for a deeper look. Here are the diagnostic tests your doctor might recommend to get to the root of persistent heartburn.
Upper GI endoscopy. This is the most commonly ordered first test when symptoms are worrisome. The patient receives intravenous medicine to induce relaxation, known as conscious sedation, and the doctor sprays a local anesthetic at the back of the throat to prevent gagging. The doctor then passes a flexible tube called an endoscope down the throat. A light and camera on the tube let the doctor inspect the lining of the esophagus, stomach, and first part of the small intestine for irritation, ulcers, or strictures. Special tools can be threaded through the endoscope to take a biopsy (tissue sample) if needed.
Barium study. After the patient drinks a liquid barium mixture, an x-ray of the chest and upper abdomen is taken. Barium outlines the esophagus on the image and helps the physician spot problems such as a hiatal hernia, esophageal ulcers, or a stricture (narrowing). When the stomach and first part of the small intestine are also examined, the test is called an upper GI series.
PH monitoring. Used less often than the tests above, this test tracks reflux episodes over 24 hours through a thin, acid-sensing probe passed through the nose and positioned at the bottom of the esophagus, just above the lower esophageal sphincter (LES). It is an excellent way to document acid reflux in people with unexplained chest pain, coughing, wheezing, or hoarseness, and it is also used to judge how well acid-suppressing drugs are working when symptoms persist. A wireless version sits inside a capsule that looks like a pill; placed in the esophagus, it can monitor pH for 48 hours, covering periods both on and off acid-suppressing therapy. The wireless system is especially useful in people who do not respond to PPIs.
Impedance testing. Done at the same time as pH monitoring, this test measures how well food and gas pass through the esophagus and is a good way to evaluate both acid and non-acid reflux.
