Diagnosis gastroesophageal reflux disease

(Annals 2015;163:ITC1; Nat Rev Gastro Hepatol 2016;13:501)

• Clinical diagnosis based on sx and response to empiric trial of PPI (“PPI test”)
• EGD if: Ø response to PPI or alarm features: dysphagia, vomiting, ↓ wt, anemia, age >60
• If dx uncertain & EGD nl → esoph manometry w/ 24-h pH monitoring ± impedance to dx:
• do not respond to usual antireflux medications. or prior to invasive antireflux therapy
  • Ambulatory pH impedance monitoring

Nonerosive reflux disease

• no erosion, ulceration or Barrett’s; ½ abnl pH.
• Unpredictable response to PPI.
• Most will not progress to erosive esophagitis or Barrett’s.

Reflux hypersensitivity

• nl acid exposure on pH/impedance w/ symptom-reflux assoc.

Functional heartburn

• nl acid exposure on pH/impedance w/o symptom-reflux assoc.