Table of Contents
What Causes Heartburn?Heartburn occurs when liquid contents from the stomach are regurgitated (reflux) up the esophagus. Heartburn causes pain that is typically described as “burning” in the chest. Pain may be experienced lower down, closer to the stomach, and may also be felt high in the neck and throat. Occasionally, heartburn discomfort can radiate through to the upper back. Severe heartburn is sometimes mistaken for a heart attack. For many people, heartburn is a problem that plagues them intermittently throughout their entire lives.
GERD (gastroesophageal reflux disease) is the term used to describe heartburn. GERD can result in inflammation of the esophagus in some people. Liquid that is regurgitated from the stomach contains acids and an enzyme called Pepsin, the purpose of which is to begin the process of digesting food in the stomach. GERD is generally chronic, although people may have periods of time where they are free from heartburn symptoms. Many people obtain temporary relief of heartburn by taking antacids; drugs called PPIs (proton pump inhibitors) can also relieve chronic heartburn by decreasing acid production in the stomach.
GERD that is untreated can sometimes lead to complications such as:
- Ulceration of the esophagus
- Stricture (narrowing) of the esophagus
- Bleeding (due to erosion of esophageal blood vessels)
- Barrett’s esophagus (changes in the cells that line the esophagus, sometimes leading to cancerous changes)
- Inflammation of the larynx and throat
- Aspiration pneumonia (a type of pneumonia caused when refluxed material enters the lungs)
- Fluid in the middle ears/sinuses
What Tests Can Diagnose GERD?
There are several tests that may be done to test for GERD. Some are used more frequently than others. The following are the most common tests used to diagnose GERD:
- Therapeutic trial of meds: when a physician suspects GERD based on patient symptoms, he/she may elect to trial a medication for GERD to see if symptoms improve. Medications used to treat GERD include Zantac, Prilosec, Pantoloc, Losec and others. If the patient feels better, the medication is continued and the doctor can assume that GERD is the cause of the symptoms.
- EGD (esophago-gastro-duodenoscopy): in this test, the patient swallows a thin tube with an optical system mounted so that the viewer can visualize the lining of the esophagus, stomach and duodenum for signs of inflammation and ulcers, as well as other complications of GERD that may be present. Patients are often sedated for this procedure.
- Tissue biopsies: biopsies of the esophagus and stomach lining can be obtained through an endoscope to diagnose various conditions, such as cancer, Barrett’s esophagus and other conditions of the esophagus and stomach. Tissue biopsies are usually obtained when an EGD is performed.
- Barium swallow: in this test the patient swallows barium, a contrast material that helps to show abnormalities of the esophagus, stomach and duodenum. Once the barium has been swallowed, serial x-rays are obtained. This test may show ulcers, strictures and other complications of GERD, but is often not a sensitive test for diagnosing GERD. In other words, the patient may have GERD but a barium exam may not show this fact.
- Examination of the throat by an ENT: patients often end up being referred to an ENT when their primary physician is unsure of the cause of their patient’s symptoms, particularly if their heartburn results in a sore throat or hoarse voice. The ENT specialist may find signs of inflammation in the throat and larynx if the patient has GERD.
- Esophageal acid testing: this is considered the “gold standard” in testing for GERD. In this test, a small tube is passed through the nose and into the esophagus. A sensor located on the tip of the catheter senses acid and records levels of acid in the esophagus over a 24-hour period.
- Esophageal/gastric motility tests: esophageal and gastric motility disorders are often related to GERD. These tests help to determine if impaired motility may be a causative factor in GERD.