Diagnosis of gastro-oesophageal reflux in adults

Upper gastrointestinal endoscopy is not a sensitive diagnostic investigation for gastro-oesophageal reflux disease (GORD). Approximately two-thirds of all people with reflux symptoms have no evidence of macroscopic inflammation on upper gastrointestinal endoscopy (ie nonerosive reflux disease). The rest have mucosal damage that ranges from subtle endoscopic or histological changes only, to minor erosions to circumferential ulceration to metaplasia (ie Barrett oesophagus). Severity of symptoms is not a reliable indicator of the severity of disease.

Upper gastrointestinal endoscopy is only indicated when the diagnosis is unclear or complications are suspected—see Indications for upper gastrointestinal endoscopy in patients with symptoms suspected to be due to gastro-oesophageal reflux. Endoscopy is not routinely recommended for patients who have typical symptoms of gastro-oesophageal reflux (heartburn or regurgitation) that respond to treatment. Endoscopic findings must be interpreted in the context of any acid suppression therapy the patient is taking.

Barium swallow and nuclear medicine studies are not recommended to diagnose GORD as they are not sensitive or specific diagnostic investigations for GORD. Gastro-oesophageal reflux can be directly measured using ambulatory pH (acid reflux) or impedance (acid and non-acid reflux) monitoring. These tests can also provide information on the relationship between reflux events and symptoms. Ambulatory testing is most commonly used in preoperative assessment (before fundoplication) or when there is diagnostic uncertainty.