Gastric reflux, also known as gastroesophageal reflux disease or GERD, is a common stomach disorder that can affect anyone at any age. Your esophagus is the tube that connects your mouth and throat to your stomach. The foods and fluids you eat pass through your esophagus and stomach and then continue on their way to your digestive tract. Sometimes the lower esophageal muscle does not work well and allows stomach acid and food particles to travel up the esophagus and throat. This results in the symptoms associated with gastric reflux or GERD. The only way to be sure that you are suffering from acid reflux is to see a doctor for an exam and a diagnosis.
Part 1 of 3: Identify the problem
Step 1. Know the symptoms of gastric reflux
Common signs of gastric reflux are heartburn, chest pain, swallowing problems, chronic dry cough or hoarseness, sore throat, sour taste in the mouth, regurgitation of food or stomach juices and a lump in the throat.
- “Heartburn” is a term commonly used to describe these symptoms together. The accepted definition of heartburn is indigestion causing a burning sensation extending from the chest to the throat and often accompanied by a bitter taste.
- Rarer symptoms of gastric reflux are nausea, vomiting, difficulty breathing, ear pain, laryngitis, the constant need to clear your throat, deterioration of tooth enamel, and other dental problems.
- Gastric reflux is responsible for over 50% of cases of non-cardiac chest pain. Most people go to an emergency room or emergency care center with chest pain thinking they are going to have a heart attack.
- Always seek medical assistance in the event of sudden or life-threatening symptoms. If you don't have any heart problems, go to your regular doctor to see if acid reflux is to blame.
Step 2. Inform your doctor about your medical history
Give it as much detail as possible. Treating your gastric reflux will be more effective if your doctor knows about your other problems or illnesses.
- The medical history includes a complete history of your previous digestive problems, persistent sore throat, cough, hoarseness or laryngitis, upset stomach, and stomach ulcers or other gastrointestinal conditions.
- Tell your doctor about any allergies, especially because you will need to have tests using unusual medicines and contrast media.
- All your health problems should be reported to the doctor, but also to other specialists such as allergists or anesthetists who take care of you. Remember to prevent them in case of pregnancy (for women).
Step 3. Give her a complete list of your medications
The list should include any prescription drugs you take, over-the-counter products, vitamins, and herbal supplements. Always tell doctors when you are taking a new medicine (when you start taking something over-the-counter) or when you change or stop an existing treatment.
- Sometimes over-the-counter medications, herbal supplements, and vitamins that you think are harmless are the main cause of your stomach problem.
- Follow your doctor's advice on how to stop and then resume your medication when having the test procedures.
Step 4. Familiarize yourself with the characteristics of gastric reflux
Generally speaking, gastric reflux can be divided into 3 categories. It is important that you learn to identify them because your doctor will use this information to confirm their diagnosis.
- The 1st category is called functional or physiological GERD.
- This category includes people who do not have any risk factors for gastric reflux or any medical condition that may be causing the symptoms.
- People falling into this category are treated by changing their lifestyle and giving them lighter forms of medication. The diagnostic test is not necessary to start treatment as long as there are no medical problems or risk factors. It all depends on your doctor.
- The 2nd category is called gastroesophageal reflux disease. People falling into this category develop symptoms of gastric reflux and possible complications from more severe and persistent symptoms. Sometimes they have other illnesses that make their acid reflux worse.
- Persistent acid reflux left untreated for an extended period of time falls into this category.
- The 3rd category is called secondary GERD. This means that an underlying medical problem is causing or contributing to the development of acid reflux.
- For example, people with a gastrointestinal disorder responsible for stomach emptying problems may develop gastric reflux due to this phenomenon.
Step 5. Don't ignore your symptoms
In the event of gastric reflux, follow the treatment prescribed by your doctor. If the treatment doesn't work, tell it. You are at risk of developing serious complications.
- The most common complication that can result from gastric reflux is called esophagitis. This means the esophagus is inflamed, irritated, or has ulcers in places.
- This problem worsens over time if gastric reflux is not properly treated.
- Stenosis is a complication that often develops in advanced forms of esophagitis. It is usually caused by continuous exposure of the esophagus to stomach acid. Localized inflammation, scar tissue, or other damage to the lining of the esophagus causes it to shrink. Food has difficulty passing through and the affected person suffers from swallowing problems.
- People with stenosis caused by prolonged gastric reflux vomit undigested food or have difficulty swallowing solid food. In most cases, surgery is needed to resolve the problem.
- Another possible complication is called Barrett's esophagus. It affects approximately 8 to 15% of people with gastric reflux. Prolonged exposure of the esophagus to stomach acid causes a change in the cellular level and leads to dysplasia.
- Dysplasia is a change seen in tissue during the early stages of cancer.
- The development of Barrett's esophagus leads to a type of cancer called adenocarcinoma which is the most common type of cancer of the esophagus. It is the most serious complication associated with GERD.
Part 2 of 3: take a diagnostic test
Step 1. Know what are the diagnostic methods for gastric reflux
Doctors make their diagnosis based on symptoms and response to treatment. Your doctor will perform a differential diagnosis to detect diseases that may have symptoms similar to those of GERD: heartburn, atypical achalasia or spasms of the distal esophagus. Depending on your symptoms, your doctor may prescribe a proton pump inhibitor that blocks the production of acid in your stomach. If this medicine does not cause a response, your doctor may do additional tests. The specific tests listed below are usually only used if GERD is not clearly identified or if you have more severe symptoms.
- Some tests, such as esophageal manometry, are done for preoperative evaluation.
- Endoscopy is performed in case of alarming symptoms, but also to identify patients with a high risk of complications.
Step 2. Have an upper gastrointestinal endoscopy
An upper digestive endoscopy helps assess general anatomy and identify structural problems or complications caused by the disease. This test confirms the existence of gastric reflux and determines the extent of damage to the esophagus. Other conditions of the upper digestive tract are also diagnosed this way.
- Other conditions that can be diagnosed by upper gastrointestinal endoscopy include anemia, unexplained nausea and vomiting, ulcers, bleeding, and precancerous lesions.
- An upper digestive endoscopy is performed by inserting an endoscope (a long flexible tube with a camera on its end) down the throat towards the esophagus. It allows the doctor to observe the walls of the upper digestive tract, including the esophagus.
Step 3. Prepare for an upper gastrointestinal endoscopy
Your doctor will give you clear instructions to follow before the procedure. Follow them scrupulously. The information listed here is for reference only and may differ from that provided by your doctor.
- Avoid eating or drinking anything within 8 hours of the procedure. In order for the doctor to clearly see the walls of your esophagus and stomach, your stomach must be empty.
- Avoid smoking, eating any food, drinking any liquid (including water), and chewing gum.
- Upper gastrointestinal endoscopy is generally performed in a hospital setting or in an outpatient surgery center since it requires a light sedative.
- Consider coming with someone. You will be given a mild form of anesthetic and you will not be allowed to drive immediately after.
- Some doctors do this procedure without using a sedative, but it is quite rare.
Step 4. Know what to expect during the procedure
Know what to expect during and immediately after the procedure. You may be asked to gargle with numbing liquid or you may be sprayed with the liquid in the back of your throat. This blocks the gag reflex during tube insertion.
- You will be lying on your side on the examination table during the procedure. You will be given an intravenous injection of a sedative into the arm or hand. Nurses or other doctors will stay with you to monitor your vital signs during the procedure.
- Your doctor will insert a long, thin tube fitted with a camera into your mouth and gently push it through your esophagus and stomach. This will allow him to observe the tissues in your upper digestive tract and in your stomach.
- If necessary, the doctor will take a tissue biopsy during the examination. The biopsy is done using an instrument carefully inserted through the tube that passes through your upper digestive tract. You will not feel anything during the biopsy.
- Sometimes air is sent to the stomach and duodenum which is the highest part of your intestine. This allows the doctor to see all the tissues and walls and therefore better determine the cause of the problem.
- The whole procedure usually takes 15 to 30 minutes. In most cases, the doctor will immediately inform you of what he sees. The results of the tissue biopsy are only known after a few days.
- You will stay in the hospital or center for a few hours after the procedure while the sedatives stop working and to check that the procedure has not caused any problems.
- Most people feel bloated or nauseous for a few hours and have a sore throat for 2 days after the procedure. You will be asked to rest at home for the rest of the day and possibly the next day as well. Resume your normal diet once your sore throat has subsided and you have no more problems swallowing your food.
Step 5. Take a manometry
Manometry is performed to obtain detailed information on candidates for surgery. It allows the doctor to assess how well the esophagus is working and to find out if there are any problems that can be resolved with surgery.
- Manometry is a procedure that provides important information about the overall functioning of the esophagus and its sphincter, which constricts or closes after passing food.
- During manometry, the doctor can measure the pressure exerted by the lower esophageal sphincter, identify problems with motility, assess the contraction and relaxation of the esophagus, but also identify other problems relating to swallowing.
Step 6. Prepare for a manometry
Your doctor will give you clear instructions so you can prepare for the manometry. Follow its recommendations scrupulously.
You will be asked not to eat or drink anything during the 8 hours before the exam. If the manometry is scheduled for early the next day, you should not eat or drink after midnight
Step 7. Know what to expect before the procedure
Know what to expect before and immediately after the procedure. You will not be given a painkiller during the procedure, but medication will be used to make it easier.
- Medicines to numb the nasal and respiratory passages are used just before the start of the procedure. This makes it easier to insert the tube.
- The procedure involves passing a thin pressure-sensitive tube through the nose and then through the throat and esophagus to the stomach. You will be asked to remain seated while the tube is inserted.
- You may experience a feeling of nausea and discomfort as the tube passes through your nose and throat.
- The tube is pulled back slightly once it reaches your stomach to make sure it's in your esophagus. You will be asked to remain seated or lie on your back for the remainder of the procedure.
- Once the tube is properly seated, you will be asked to swallow small sips of water. The catheter (or tube) is connected to a computer and collects important information as you swallow.
- Breathe slowly and evenly, keeping your calm. Only swallow when asked to do so.
- The information collected by the computer helps identify the proper functioning of the sphincter muscles in your esophagus. The procedure also checks the overall functioning of the esophagus (contraction, relaxation and motility).
- You may have a slightly bleeding nose, wet eyes, a sore throat during and after the manometry. It is also possible, but very rarely, that your esophagus is damaged during the procedure.
- Your doctor will tell you when you are able to eat and drink again. Normally, this is possible immediately after the procedure.
- The entire procedure takes 30 minutes to 1 hour. It is usually performed in a hospital setting or in a surgical center.
- The results are available after a few days.
Part 3 of 3: undergo further testing procedures
Step 1. Know what your other options are
Your doctor may need more information about your problem to properly treat gastric reflux. In addition to the mandatory diagnostic test, other tests are sometimes done to assess those affected and related problems.
- The 2 most common tests performed to confirm a diagnosis of gastric reflux or to identify problems with similar symptoms are a 24-hour pH measurement and an oes-gastroduodenal transit.
- These procedures are useful for diagnosing related problems (such as peptic ulcer disease) and for monitoring treatment progress.
- Once treatment for gastric reflux has started, it is important to assess its effectiveness. This is done by controlling the symptoms although sometimes starting a procedure over to compare the results is the most effective technique.
Step 2. Take a 24 hour pH measurement
24-hour pH measurement is used to confirm the diagnosis of gastric reflux in people with the rarest symptoms of GERD and if the endoscopy results are inconclusive.
- It is also used to determine the effectiveness of certain treatments and to find the cause of other problems such as nighttime coughs and hoarseness.
- The test measures the pH of the esophagus over a 24 hour period. It helps your doctor know if the acid is in the esophagus when it shouldn't.
- Your doctor will give you instructions on how to prepare for the exam. This usually involves eating nothing and drinking nothing 2 hours before the procedure.
- During the procedure, an anesthetic will be injected into your nasal passages to avoid the discomfort of inserting the tube. Once the tube is in place, it will be secured with an adhesive tube on your face.
- A small carrying bag / backpack containing a recording device is attached to the tube. You will also be given a diary to record specific details of the symptoms you experience when you drink or eat and other information your doctor needs to know.
- The recording device collects information for 24 hours. This information correlates with your journal notes to find out if there are any issues with the abnormal acid level in your esophagus. After 18-24 hours, you will need to return to the hospital or clinic to remove the tube.
- Avoid changing your routine as much as possible for accurate information gathering.
Step 3. Go through an oeso-gastroduodenal transit
An esophageal-gastroduodenal transit uses fluoroscopy or constant, real-time x-rays to obtain images of the esophagus, stomach, and small intestine. The procedure is non-invasive and requires a contrast agent called barium to check for problems in your upper gastrointestinal tract. Many medical problems like gastric reflux can be diagnosed or confirmed using duodenal gastroduodenal transit.
- Your doctor will give you detailed instructions on how to prepare for the procedure. Most of the time, you will be asked not to chew gum and not to eat or drink anything (including your medications) for the hours before the procedure.
- The procedure is performed in a hospital, clinic or surgery center. You will be monitored by a radiologist as fluoroscopy is required. Fluoroscopy is a form of x-ray.
- Jewelry, braces, glasses and other metal items should be removed prior to surgery. You will be asked to wear a gown during the procedure.
- You will be asked to drink a contrast medium such as barium and then lie down on a special table that is part of the fluoroscopy equipment. This makes your organs visible and allows the radiologist to see how they are functioning in real time.
- Photos are taken as the contrast medium passes through your upper digestive tract. The table can tilt or move during the procedure to obtain precise images. The complete exam lasts between 20 and 30 minutes.
- During and after the test, you may feel bloating if gas-producing equipment is used.
- In most cases, you can immediately resume your normal diet and your usual medications after the procedure. Barium may stain your stools gray or white, and you may experience constipation 2-3 days later. Drink more fluids if needed to help your body get back to normal.
- The radiologist will review the results of your exam and send a full report to your doctor. The latter will inform you of these results.