Diagnostic Studies in GERD

The most common diagnostic studies in GERD are as follows:

• Empiric therapy with PPI

• Barium Swallow (upper GI X-Ray)

• Endoscopy with or without Biopsy pathology

• Manometry with or without impedance

pH studies including:

• 24 hour pH

• Bravo 48 hour pH

• Impendence 24 hour pH

Impedance pH study is the most useful modality recently developed for evaluation of difficult to manage GERD patients. Impedance determines refluxate presence, distribution, clearing time, liquid, gas or mixed.

Impedance pH (MII) shows GER contents: Acid reflux (pH<4.0), Non-acid reflux (pH>4.0 and up to 1 pH pint drop), Minor acid reflux (pH>4.0 but 2 pH point drop), Acid re-reflux (pH <4.0 and may not change), MII Manometry determines bolus transfer of liquids and solids.

Clinical indications of Impedance pH testing:

• Patients with persistent symptoms on PPI therapy
• Patients with reflux symptoms and achlorhidria (i.e. atrophic gastritis)
• Patients with reflux symptoms after surgical gastrectomy
• Patients with primary post-prandial symptoms
• Patients with ENT and Pulmonary symptoms
• Patients with reflux symptoms and frequent meal ingestion (i.e. infants)