Upper G.I. Surgery
Gastroesophageal Reflux Disease (GERD)
Diagnosis and Diagnostic Testing of the Esophagus/Stomach
A detailed history is vital for an accurate diagnosis. Useful investigations may include ambulatory Esophageal pH Monitoring, barium swallow X-rays, esophageal manometry, and Esophagogastroduodenoscopy (EGD).
It involves insertion of a thin scope through the mouth and throat into the esophagus and stomach (usually while the patient is sedated) in order to assess the internal surfaces of the esophagus, stomach, and duodenum. Biopsies (taking samples of the tissure) can also be performed during endoscopy. This is probably the single most important test that anyone with GERD should have. It is the only way to detect damage and complications early when they are easier to treat. Many of the complications of GERD have no symptoms until they are very advanced and difficult to treat.
Esophageal pH Monitoring
It is the current gold standard for diagnosis of gastroesophageal reflux disease (GERD). It provides direct physiologic measurement of acid in the esophagus and is the most objective method to document reflux disease, assess the severity of the disease and monitor the response of the disease to medical or surgical treatment. It can also be used in diagnosing laryngopharyngeal reflux.
In the past, an indwelling nasoesophageal catheter was the only way to measure esophageal acid exposure. Because this method is associated with nasal and pharyngeal discomfort and rhinorrhea, patients may have limited their activity and become more sedentary during the monitored period. This may have resulted in less reflux and a false negative test. The Bravo pH monitor is a catheter-free radio telemetric system which allows a longer period of monitoring and is better tolerated.
A sample of Bravo pH tracing recorded over 48 hours
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