ASGE Esophagology General GI Practice Virtual Program (LIVE Virtual) | April 2021-The Diagnostic Toolbox for GERD: When to use what

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GERD (gastroesophageal reflux disease) is a complex condition with various symptoms and causes. There is no one-size-fits-all approach to diagnosing GERD, and no gold standard test for it. However, there are several diagnostic tools that can be used to help determine the presence of GERD.<br /><br />One commonly used method is a trial of proton pump inhibitor (PPI) therapy, which involves taking a PPI medication daily for a period of time. While this method is low cost and low risk, it has a sensitivity of 78% and specificity of only 54%.<br /><br />Another diagnostic tool is an upper endoscopy (EGD), which is recommended in cases where there are GERD symptoms and alarm symptoms (such as dysphagia, weight loss, bleeding, or anemia), inadequate response to PPI therapy, or chest pain without heartburn and normal cardiac workup. During an EGD, the doctor can assess the condition of the esophagus, including the presence of erosions, Barrett's esophagus, and strictures.<br /><br />Other tools that can be used in the diagnosis of GERD include esophagram (barium swallow), reflux monitoring (which measures acid exposure time, number of reflux events, and reflux symptom correlation), biopsy (which is not sensitive or specific for diagnosing GERD), high-resolution manometry (which assesses peristalsis and esophageal clearance), and mucosal impedance.<br /><br />It is important to note that GERD diagnosis should not solely rely on one test or symptom, but should be evaluated in the context of the patient's history and clinical presentation. The choice of diagnostic tool depends on the individual patient and their symptoms.<br /><br />Overall, diagnosing GERD can be challenging, and a comprehensive approach using multiple diagnostic tools may be necessary to accurately diagnose and treat the condition.

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Felice Schnoll-Sussman, MD FASGE

Keywords

GERD

gastroesophageal reflux disease

diagnosing GERD

gold standard test

proton pump inhibitor therapy

upper endoscopy

EGD

esophagus condition

diagnostic tools

multiple diagnostic tools