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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)
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