Diagnosis

The Importance of Diagnosing Reflux

It goes without saying that reaching the right diagnosis is the cornerstone of medical practice. Historically, doctors relied on listening to a patient’s history and examination. These remain essential to the diagnostic process but technology has radically advanced the tests at our disposal and our understanding of disease. Modern diagnostics have revolutionised our ability to make the right treatment decisions.

This is particularly the case for patients with symptoms derived from the “foregut”, the oesophagus, stomach and small bowel, including those associated with reflux. Understanding the structure, for instance the presence of ulcers, Barrett’s oesophagus or hiatus hernias can be obtained from optical examination during endoscopy in which a camera is inserted through the foregut.

But, while tests designed to provide structural information can in themselves be diagnostic, this is often not enough. While a normal endoscopy excludes some conditions, it provide no information about function. And the problem with “reflux” and other foregut conditions is that similar or identical symptoms can be caused by multiple conditions requiring often very different treatments. For instance, difficulty swallowing may be caused by a narrowing in the oesophagus which will be seen during endoscopy, but also motility disorders of oesophageal neuro-muscular function which won’t. And there are several different motility disorders often requiring different treatments; diagnosis of these requires functional tests. Similarly, heartburn and “indigestion” have multiple potential causes and simply relying on the symptom and response to anti-acid medications is often not diagnostic. And while reflux itself can be diagnosed when clear evidence is identified during an endoscopy such as Barrett’s oesophagus or severe inflammation (reflux oesophagitis), most people with reflux have no signs at endoscopy.

This is where tests that measure function can be essential. These include physiological oesophageal studies. These include oesophageal manometry (the measurement of pressure) which measures how the nerves and muscles including valves in the oesophagus are working. Reflux studies (pH which measures just acid and the modern Impedance which can record non-acidic and gaseous events) record reflux events and their association with symptoms.

Increasingly we’re also recognising that conditions affecting the small bowel can cause symptoms in the stomach, oesophagus or even throat. There’s increasing evidence that SIBO in particular may cause reflux type symptoms and so breath tests to check for SIBO may be indicated.

While nearly 1 million people each year undergo endoscopy in the UK, functional/physiology tests are not widely available. Typically these are offered to only a small group of patients, many more people would benefit from a definitive diagnosis and it’s the RefluxUK mission to find the cause of your symptoms and to give you the certainty you need to make decisions about your future treatment whether that’s surgery or as is far more often the case other treatments.

So, we will often suggest a range of tests to help get to this point. 

Reflux Diagnostic Tests

When selecting RefluxUK you have the reassurance that any testing we recommend will be carried out by real specialists in their field and knowing that the results will be reviewed by a team of experts before we present our findings and treatment.