• Barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. With this test, you drink a solution and then x rays are taken. The test will not detect mild irritation, although strictures—narrowing of the esophagus—and ulcers can be observed.
• Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a
doctor’s office. The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin,
flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny
camera, the endoscope allows the doctor to see the surface of the esophagus and search for abnormalities. If you
have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other
tests are needed to confirm GERD. The doctor also may perform a biopsy. Tiny tweezers, called forceps, are
passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus.
The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other prob
lems if infection or abnormal growths are not found.
• pH monitoring examination involves the doctor either inserting a small tube into the esophagus or clipping a tiny
device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus. This test can be useful if combined with a carefully completed diary— recording when, what, and amounts the person eats—which allows the doctor to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symp
toms, including wheezing and coughing, are triggered by reflux.
A completely accurate diagnostic test for GERD does not exist, and tests have not consistently shown that acid exposure to the lower esophagus directly correlates with damage to the lining.
Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms. Surgery may also be
a reasonable alternative to a lifetime of drugs and discomfort.