Overview of the Tools for the Diagnosis of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is often diagnosed based upon symptom presentation along with a good response to a trial of acid-suppressing medication. Additional diagnostic tools for gastroesophageal reflux disease include endoscopy to document mucosal damage, and ambulatory pH or impedance pH monitoring to quantify reflux and evaluate the relationship between reflux episodes and symptoms. Gastroesophageal reflux disease cannot be diagnosed by barium esophagram or esophageal manometry. While diagnosing gastroesophageal reflux disease by symptoms and response to acid suppression is acceptable in some settings, endoscopy is recommended when there are alarm features such as dysphagia or weight loss. Objective documentation of gastroesophageal reflux disease is mandatory prior to antireflux surgery. Patients with extraesophageal symptoms or refractory gastroesophageal reflux disease may require further evaluation by endoscopy and reflux monitoring. Finally, in some patients the reported symptoms may be due to causes other than gastroesophageal reflux disease, including functional disorders; in these patients, endoscopy and reflux monitoring can be valuable tools to exclude gastroesophageal reflux disease.