The American Journal of Medicine
Volume 123, Issue 7 , Pages 583-592, July 2010

The Diagnosis of Gastroesophageal Reflux Disease

  • Brian E. Lacy, PhD, MD

      Affiliations

    • Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • Corresponding Author InformationReprint requests should be addressed to Brian E. Lacy, PhD, MD, Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Area 4C, Lebanon, NH 03756
    • ,
  • Kirsten Weiser, MD, MPh

      Affiliations

    • Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • Jocelyn Chertoff, MD, MS

      Affiliations

    • Division of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • Ronnie Fass, MD

      Affiliations

    • Southern Arizona VA Health Care System, Tucson
    • ,
  • John E. Pandolfino, MD

      Affiliations

    • Northwestern University Feinberg School of Medicine, Chicago, Ill
    • ,
  • Joel E. Richter, MD

      Affiliations

    • Temple University School of Medicine, Philadelphia, Pa
    • ,
  • Richard I. Rothstein, MD

      Affiliations

    • Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • Chad Spangler, MD

      Affiliations

    • Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • Michael F. Vaezi, MD, PhD, MSc

      Affiliations

    • Vanderbilt University Medical Center, Nashville Tenn

published online 20 May 2010.

Abstract 

Background

Gastroesophageal reflux disease is a highly prevalent condition that imposes a significant economic impact on the US health care system. The utility of commonly used tests for the diagnosis of gastroesophageal reflux disease has not been adequately reviewed.

Methods

A comprehensive review of the literature was undertaken to provide an evidence-based approach to the diagnosis of gastroesophageal reflux disease. EMBASE (1980-December 2008), OVID MEDLINE, and PubMed, (1966-December 2008) were searched using “gastroesophageal reflux” and “adults” with other terms, including medications, diagnostic tests, symptoms, and epidemiologic terms. Studies were limited to human trials, English language, and full articles.

Results

Heartburn is a reasonably sensitive symptom for the diagnosis of gastroesophageal reflux disease, although it does not reliably predict esophagitis. Standardized questionnaires have limited specificity, whereas the double-contrast barium swallow has a low sensitivity to diagnose gastroesophageal reflux. The role of esophageal manometry is limited to accurate placement of a pH-measuring device. pH testing has reasonable sensitivity and specificity for the diagnosis of gastroesophageal reflux disease. The sensitivity of upper endoscopy to diagnose gastroesophageal reflux is lower than that of pH tests.

Conclusion

The diagnosis of gastroesophageal reflux disease remains difficult. In the absence of alarm symptoms, empiric treatment with acid suppression is warranted. pH testing provides valuable information in many patients, although the clinical utility of newer tests needs to be determined. Endoscopy should not be the first test used to diagnose gastroesophageal reflux.

Keywords: Acid reflux, Bravo pH capsule, Esophageal manometry, Esophagus, Gastroesophageal reflux disease, Impedance, pH probe, Proton pump inhibitor

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 Funding: None.

 Conflict of Interest: Drs Weiser, Spangler, Vaezi, and Chertoff do not have any potential conflicts of interest to disclose. Dr Lacy has received investigator-initiated, unrestricted funding for clinical research projects from AstraZeneca, Novartis, and Takeda. Dr Fass has received investigator-initiated research funds from AstraZeneca, Wyeth, and Takeda. He serves as a consultant to Takeda, AstraZeneca, Eisai, GlaxoSmithKline, Vecta, Procter & Gamble, Pfizer, Xenoport, and Addex. Dr Richter has served on the speaker's bureaus for AstraZeneca and TAP. Dr Pandolfino has received investigator-initiated research funds from AstraZeneca, Santarus, Medtronics, and Crospon. Dr Rothstein has received investigator-initiated research funds for studies involving the endoscopic treatment of reflux disease from Ethicon, Olympus, and Bard.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(10)00069-0

doi:10.1016/j.amjmed.2010.01.007

The American Journal of Medicine
Volume 123, Issue 7 , Pages 583-592, July 2010

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