By Dr Ananya Mandal, MD
Heartburn is a symptom that is often indicative of an underlying condition of acid reflux or Gastro-esophageal reflux disorder. Diagnosis of heartburn is vital as it may mimic a heart attack or other chest pathologies.
Diagnosis of heartburn or acid reflux disorder includes the following.
This involves taking a detailed assessment of the condition in the past of its presence in the family. History of intake of certain drugs (like pain relievers) or other conditions that may raise the risk of acid reflux like smoking and alcoholism is important.
Factors that aggravate the condition including lying down, taking spicy or fatty foods etc. are noted. Factors that relieve the condition like intake of food or water are also enquired of.
Physical examination looks for features like anemia, weight loss and malnutrition due to difficulty in swallowing. Reflux of acid may also result in complications of lungs like lung abscess, pneumonia and interstitial pulmonary fibrosis.
Ruling out other conditions
Heartburn may also be caused by heart attacks, rib injury, esophagitis due to swallowed corrosives or drugs like NSAIDS, peptic ulcer, infections in HIV positive and other immune-suppressed patients due to herpes, candida, cytomegalovirus etc. These need to be ruled out.
Endoscopy is the next step. In this an instrument called the endoscope examines the insides of the esophagus. This is a long thin flexible tube with a camera on its tip. The camera sends images of the examined area to the external monitor.
The endoscope is inserted into the mouth and passed into the esophagus. The endoscope checks the insides of the esophagus for possible irritation and inflammation caused by the refluxed acid.
Acid reflux may also be diagnosed using manometry. Manometry is suggested if endoscopy does not find any evidence of damage to the esophagus. This test assesses the strength of the lower esophageal sphincter (LES). It measures the pressure levels inside the sphincter muscle.
A small tube is passed into the esophagus up to the LES. The tube contains a number of pressure sensors that are connected to an external computer. The patient is then given some food and drink to swallow and the pressure at the LES is recorded.
A 24 hour pH monitoring may be recommended. The lower the pH level within the esophagus, the greater is the acid content.
Barium swallow test
A Barium swallow test may be advised to check on the blockages or problems with the muscles used during swallowing.
Routine blood tests
Routine blood tests are prescribed. This helps to detect anemia caused due to malnutrition.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)