Diagnostic Investigations in GERD

Abstract

GERD presents with a large diversity of different symptoms. Despite typical symptoms such as heartburn and regurgitation, GERD may cause also a variety of different symptoms such as chest pain, chronic cough, hoarseness, epigastric pain, and/or nausea. The Montréal classification of GERD has described the presence of symptoms in GERD. Other functional and somatoform disorders may also present with “reflux-like” symptoms, creating an overlap with the clinical presentation of GERD. Therefore, symptoms may be in some cases misleading regarding a sufficient diagnosis for therapeutic decision making. As a consequence, diagnostic investigations in GERD are very important. Current technology allows for a very comprehensive assessment and understanding of the morphologic, anatomical, and functional alterations that emerge with the development of GERD. High Resolution Manometry and Dynamic Barium Sandwich videography are very helpful. Endoscopy is especially important in exclusion of malignant disease and in the presence of alarm symptoms such as dysphagia, retrosternal pain, and bleeding. With endoscopy, it is possible to establish the diagnosis of GERD and its grade of severity. For diagnostic workup prior to surgery endoscopy, 24-h-pH-monitoring and manometry are important for the optimal selection for patients.