Chronic heartburn is more than a simple inconvenience; it is a persistent disruption that can signal serious damage to your esophagus. While many attempt to manage the burning sensation with over-the-counter antacids, clinical intervention is often necessary to reduce the risk of long-term complications like Barrett’s esophagus. Modern gastroenterology offers several precise diagnostic pathways to identify the root cause of your reflux.
When GERD Requires Medical Evaluation
GERD is suspected when reflux symptoms occur multiple times per week or fail to improve with lifestyle changes or medication. Warning signs such as difficulty swallowing, chronic cough, hoarseness, or unexplained anemia often prompt further testing. A thorough evaluation helps distinguish GERD from other conditions that can mimic reflux.
Upper Endoscopy: Examining the Esophagus and Stomach
Upper endoscopy (esophagogastroduodenoscopy or EGD) allows direct visualization of the esophagus, stomach, and upper small intestine using a thin, flexible camera. This test helps identify inflammation, erosions, strictures, Barrett’s esophagus, and hiatal hernias.
While some patients with GERD may have a normal endoscopy result, this test is especially important for those with long-standing symptoms or alarm features. If abnormalities are found, tissue samples may also be collected during this procedure.
pH Monitoring/pH Testing: Measuring Acid Reflux Episodes
Ambulatory pH monitoring (also called pH testing) is considered the most definitive test for confirming GERD. Over a 24-hour to 96-hour period, this test measures how often and for how long acid enters the esophagus. Typically, pH testing is performed using either a thin nasal catheter or a wireless capsule placed during endoscopy.
By correlating acid exposure with symptoms, pH testing provides objective evidence of reflux and helps determine whether symptoms are acid-related.
Esophageal Manometry: Evaluating Swallowing Function
Esophageal manometry assesses how well the esophageal muscles and the lower esophageal sphincter function. Although it does not diagnose GERD directly, it is essential for ruling out motility disorders and for guiding treatment decisions, particularly when procedural intervention is being considered.
Confirming GERD Before Surgical Treatment
When symptoms persist despite medical therapy, surgical treatment may be appropriate. Procedures such as fundoplication, LINX® magnetic sphincter augmentation, and hiatal hernia repair rely on accurate diagnostic testing to ensure that reflux is the true cause of symptoms. Proper evaluation helps clinicians select the most effective approach and supports long-term symptom control.
If ongoing reflux symptoms are affecting daily life or have failed to respond to standard therapy, book a consultation with our office for a comprehensive diagnostic workup to clarify the diagnosis and support informed treatment decisions.
AUTHOR: Arif Ahmad, MD, FRCS, FACS, is one of the world's pioneers in robotic bariatric surgery at Northwell Health. He has the world’s largest experience in robotic bariatric surgery. He specializes in minimally invasive surgery. Dr. Arif Ahmad specializes in laparoscopic robotic surgery and has performed over 4,000 laparoscopic robotic surgeries. He is renowned in the Long Island area for his impeccable track record of safety and success.
