Diagnostic Tests for Heartburn
BY: Susan Male-Smith
So you think you may have heartburn. Over-the-counter medicines help, but it keeps coming back. You’re thinking about consulting your doctor, but you dread the thought of diagnostic tests.
Relax. “Most often, tests aren’t needed because doctors typically diagnose heartburn from your symptoms alone or from your response to medication,” says Dr. Robert Levinson, chief of gastroenterology at Newark Beth Israel Medical Center in New Jersey.
However, if your heartburn doesn’t respond to lifestyle modifications or medication, your doctor may want to run some diagnostic tests to confirm the diagnosis. In addition, if you have chronic heartburn or GERD (gastroesophageal reflux disease), diagnostic tests may be necessary to check for complications, such as esophagitis (inflammation of the esophagus) or Barrett’s esophagus (which can lead to a rare cancer). So if you start hearing technical jargon like “barium swallow” or “endoscopy,” don’t panic. Here’s what to expect:
You drink a chalky liquid containing barium, then your torso is X-rayed. The barium allows your doctor to see the insides of your digestive tract. While not a reliable way to diagnose heartburn or GERD, this diagnostic test can help rule out other causes of heartburn-like pain, such as strictures (narrowing of the esophagus), hiatal hernias and ulcers.
Upper Endoscopy (EGD)
Your doctor places a thin, flexible, lighted instrument down your throat to examine your esophagus, stomach and the upper part of your intestines. You’ll be sedated during the test but may experience a sore throat afterward. If you’ve had heartburn for many years or have more immediate danger signals (such as trouble swallowing, chronic hoarseness or coughing), have this diagnostic test done to check for complications, recommends Levinson.
Your doctor inserts a long plastic tube through your nose, down your throat and into your stomach. It is left there for 24 hours while it measures how much and how often acid backs up from your stomach into your esophagus. This diagnostic test can help confirm a heartburn diagnosis if you have heartburn symptoms but no evidence of acid reflux.
Your doctor inserts a tube into your esophagus, which measures the pressure of your lower esophageal sphincter (LES) as it opens and closes. Since the job of the LES is to keep acid inside your stomach, low LES pressure can allow acid to reflux up, causing heartburn.
Bernstein Test (Acid Perfusion Test)
Your doctor inserts a tube through your nose and into your stomach, then drips acid through the tube, followed by saltwater, to see if either one reproduces your heartburn symptoms. This diagnostic test can be helpful in confirming whether acid reflux is the cause of your discomfort.
No one likes undergoing diagnostic tests. Fortunately, heartburn can usually be diagnosed without them. But if you need to confirm a diagnosis or rule out a complication, just remind yourself that a little discomfort now will help you feel better in the long run.
Susan Male-Smith is a registered dietitian and freelance nutrition and health writer. She has written for Family Circle, Redbook, Child and American Health, and she is a former editor of the Environmental Nutrition newsletter and co-author of Foods for Better Health. Susan is a frequent contributor to Live Right Live Well.