The majority of people who experience “reflux” symptoms undergo a trial of antacid or acid suppression medication prior to being tested to see if they have any underlying disorder or medical condition. If symptoms don’t improve quickly, if the person is over 50, or symptoms of difficulty swallowing (dysphagia) are present, then investigation to rule out serious conditions are worthwhile. No single test is able to diagnose every condition or its severity, so patients with complex problems can sometimes need to undergo several tests before they get an accurate diagnosis or management plan. Prolonged treatment without an accurate diagnosis can be unhelpful to patients, but so can “over investigation”. Tests often performed include:
- Testing for H Pylori
- Abdominal ultrasound and CT
- Endoscopy (gastroscopy)
- Barium swallow
- Oesophageal function tests
These are used when patients have persisting bothersome symptoms of reflux despite adequate treatment. The aim of these tests is to determine the severity of oesophageal acid exposure and the relationship between reflux and symptoms. We can measure acid at the lower and upper ends of the oesophagus over a 24 hour period, and also measure non-acidic and weakly acidic reflux in patients where bile reflux or other problems are felt to be responsible for symptoms.
The most common method of testing reflux is using fine catheters (approx. 3 mm wide) which are connected to an electronic device the size of a mobile phone. In order to introduce the catheter we spray the back of your nose and throat with a local anaesthetic so passing the catheter down the nose is straightforward and free of trauma. Only a small minority of patients fail to tolerate the catheter, and problems such as nose bleeds are very rare. Once the catheter has been placed people head home with a plan to eat and drink normally and to press a symptom button every time they get symptoms. It is important that patients do the things that may bring symptoms on while they are having the test done and to record symptoms when they occur otherwise the test result may be negative. The following day the catheter is removed and the results analysed.
Catheter Free Studies
Another method of reflux testing that avoids catheters involves using endoscopy to place a single-use probe into the oesophagus to perform measurements; the probe contains a battery and is connected wirelessly to an electronic device the patient carries in their pocket. The probe will measure reflux over a 48-72 hour period, after which time it detaches from the oesophagus and passes harmlessly into the toilet. This helps avoid the potential discomfort of having a catheter attached to your nose for 24 hours, but it requires an anaesthetic and endoscopy for placement and is more expensive for the person having the test performed.