Diagnosing Reflux - Gastroesophageal Reflux Disease: Digestive Disorders

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Diagnosing reflux

Many people can manage heartburn without seeking medical care, through dietary changes and over-the-counter medications (see "Self-help for reflux"). A doctor may be helpful when the symptoms are worrisome to the patient or if they interfere with sleep or daily life. If you do seek your physician's advice, providing a detailed account of your symptoms will help him or her make the diagnosis.

The doctor will review your medical history and ask detailed questions about the nature of the pain and its pattern of onset. For example, he or she may ask whether symptoms are worse after you eat a heavy meal or known dietary troublemakers such as high-fat foods or dairy products. Your doctor will want to know if bending over to tie your shoelaces or lying down aggravates the symptoms and whether the pain seems linked to anxiety or stress.

A physician may ask whether regurgitated stomach contents leave a bitter or acidic taste in your mouth. A sudden outpouring of salty fluid in the mouth, called water brash, can result from salivary secretions stimulated by reflux.

For typical reflux symptoms, doctors usually forgo diagnostic tests and proceed straight to treatment, starting with a proton pump inhibitor (PPI) such as omeprazole (Prilosec) or lansoprazole (Prevacid). If this provides relief, the odds are that the diagnosis of GERD was correct. Once the symptoms are under control, the patient may either continue with the PPI or switch to a less powerful medication. That might be an H₂-receptor antagonist (H₂ blocker) such as cimetidine (Tagamet), ranitidine (Zantac), or famotidine (Pepcid), or an antacid like Tums.

Asthma and reflux. Your doctor will be alert for other symptoms, such as frequent nonburning chest pain, bleeding into the gastrointestinal tract, dysphagia (difficulty in swallowing), hoarseness, or constant coughing and wheezing. Such symptoms may be associated with GERD, but could have other causes and might warrant tests to gain more information (see "Is this test necessary?").

For example, GERD can cause respiratory problems such as asthmatic wheezing, coughing, or hoarseness. When asthma strikes adult nonsmokers with no history of lung disease or allergies, pH monitoring studies sometimes suggest that GERD is the culprit. More than 75% of patients with asthma experience reflux.

Researchers speculate that when caustic acid refluxes into the esophagus it triggers a nerve reflex that constricts the bronchial tubes (the branches of the trachea that lead into the lungs) and produces wheezing. Aspiration of acid into the bronchi may also play a role in causing these symptoms.

On the other hand, asthma may lead to gastroesophageal reflux, rather than vice versa, since the coughing and wheezing of asthma create pressure shifts in the chest that can produce reflux. In addition, theophylline and other bronchodilators, medications used to treat asthma, may weaken the LES.

Last updated:	August 21, 2007