The Diagnosis of Gastroesophageal Reflux Disease

Brian E. Lacy*, Kirsten Weiser, Jocelyn Chertoff, Ronnie Fass, John Erik Pandolfino, Joel E. Richter, Richard I. Rothstein, Chad Spangler, Michael F. Vaezi

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

83 Scopus citations

Abstract

Background: Gastroesophageal reflux disease is a highly prevalent condition that imposes a significant economic impact on the US health care system. The utility of commonly used tests for the diagnosis of gastroesophageal reflux disease has not been adequately reviewed. Methods: A comprehensive review of the literature was undertaken to provide an evidence-based approach to the diagnosis of gastroesophageal reflux disease. EMBASE (1980-December 2008), OVID MEDLINE, and PubMed, (1966-December 2008) were searched using "gastroesophageal reflux" and "adults" with other terms, including medications, diagnostic tests, symptoms, and epidemiologic terms. Studies were limited to human trials, English language, and full articles. Results: Heartburn is a reasonably sensitive symptom for the diagnosis of gastroesophageal reflux disease, although it does not reliably predict esophagitis. Standardized questionnaires have limited specificity, whereas the double-contrast barium swallow has a low sensitivity to diagnose gastroesophageal reflux. The role of esophageal manometry is limited to accurate placement of a pH-measuring device. pH testing has reasonable sensitivity and specificity for the diagnosis of gastroesophageal reflux disease. The sensitivity of upper endoscopy to diagnose gastroesophageal reflux is lower than that of pH tests. Conclusion: The diagnosis of gastroesophageal reflux disease remains difficult. In the absence of alarm symptoms, empiric treatment with acid suppression is warranted. pH testing provides valuable information in many patients, although the clinical utility of newer tests needs to be determined. Endoscopy should not be the first test used to diagnose gastroesophageal reflux.

Original languageEnglish (US)
Pages (from-to)583-592
Number of pages10
JournalAmerican Journal of Medicine
Volume123
Issue number7
DOIs
StatePublished - Jul 1 2010

Keywords

  • Acid reflux
  • Bravo pH capsule
  • Esophageal manometry
  • Esophagus
  • Gastroesophageal reflux disease
  • Impedance
  • Proton pump inhibitor
  • pH probe

ASJC Scopus subject areas

  • Medicine(all)

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