Barium Swallow X-rays

The "barium swallow" uses x-ray films to help reveal abnormalities, such as a hiatal hernia and severe inflammation of the esophagus. A fluid containing barium is swallowed prior to a series of x-rays. Then, as the radiopaque barium solution travels through the upper digestive tract, a sequence of x-rays are taken. Mild irritation of the esophagus will not appear on this test, although narrowing, or stricture, of the esophagus, ulcers, hiatal hernia, cancer, and other problems can be seen and evaluated.

Upper Endoscopy

Upper endoscopy is a procedure in which the physician looks inside the esophagus, stomach, and duodenum (the first part of the small intestine) through a lighted endoscope embedded within a thin tube you actually "swallow" into position. Some physicians may prefer a transnasal insertion, which can be easier for you to tolerate. The procedure might be used to discover the reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain. Upper endoscopy is also called EGD, which stands for esophagogastroduodenoscopy.

Before you swallow the tube, your throat is sprayed with a numbing agent that helps to prevent gagging and eases your ability to allow the passage of the endoscope. Pain medicine and a sedative also may be used to help you relax during the exam.

The endoscope transmits an image of the inside of the esophagus, stomach, and duodenum, so the physician can directly examine the lining of these organs. The scope can also be used to inflate your stomach with air so the physician can view tissues throughout this normally flat, hollow organ. The physician can also insert instruments through the scope to remove samples of tissue, called biopsies, for further tests. When these tissues are viewed under a microscope, they can reveal damage caused by acid reflux, such as Barrett's epithelium, cancer, or chronic inflammation.

The procedure takes 20 to 30 minutes. Because you will be sedated, you will need to rest at the facility for 1 to 2 hours until the medication wears off. There are rare complications, such as bruising or puncture, however, endoscopic procedures are quite safe and most people experience nothing more than a mild sore throat after the procedure.

Ambulatory pH Monitoring

A Bravo Study, or ambulatory pH monitoring, is a diagnostic procedure that takes place over a 48-hour period to monitor the presence and amounts of acid in the esophagus. To perform the test, the doctor puts a tiny capsule into the esophagus that will stay in place for 48 hours. No antacids are taken during this time. While you go about your normal activities, the capsule provides measurements of when and how often acid enters the esophagus. This test is useful for people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.

Esophageal Manometry

Esophageal Manometry is a test that enables your doctor to evaluate the function of the esophagus by measuring the strength of muscle contraction and the coordination of the muscular action that moves food from the esophagus into the stomach when you swallow. It is performed by inserting a thin flexible tube, or catheter, from the nose through the esophagus and into the stomach. A topical anesthetic is used to help ease your discomfort as the catheter is inserted. The tube is connected to a pressure monitoring system, which exhibits pressure changes as waveforms on a screen. The lower esophageal sphincter pressure is lower in patients with GERD.

You will be in a sitting position, while the catheter is passed into the stomach and a "baseline" pressure reading will be taken before additional steps in the procedure are taken. Once the catheter is in place, you will be repositioned on your side and asked to swallow water.

Additional pressure measurements are then taken before and during withdrawal of the tube.

The test usually takes about 30 minutes and helps your doctor tell if your symptoms are related to abnormal function of the esophageal sphincter or to some other problem. Preparation for the test includes a period without food and you should tell your doctor of any medications you are taking so you can be advised about any that should be discontinued before the test.