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Heartburn is defined as an unpleasant “burning” sensation arising from the upper tummy, radiating upwards to the chest, neck and back.  The symptoms are intermittent in nature and usually precipitated by food, bending forward or lying in a recumbent position.  If you experience heartburn symptoms several times in a week, you probably have gastro-oesophageal reflux disease or GERD.  GERD is a disease in which acid from the stomach flows back upwards into the oesophagus, causing irritation and occasional damage to the lining there.

Symptoms of GERD

Other symptoms of GERD include abdominal pain, taste of acid in the throat, food getting ’stuck’ over the chest, difficulty in swallowing, excessive belching, persistent sore throat, perception of ‘lump in throad’ irrespective of swallowing, chronic cough, persistent hoarseness of voice, nausea and bloating.

Diagnosis of GERD

For those with classical symptoms of GERD and without any alarming features, doctors may initially treat them with medications, for which the proton pump inhibitor is the most effective.  A good response to two weeks of proton pump inhibitor medication is strongly supportive of the diagnosis.  If necessary, investigations may also include an endoscopy where a small, flexible tube is passed through the mouth into oesophagus and stomach.  This procedure assesses the extent of damage to the oesophageal lining and tissue specimens can be obtained for evaluation

Barium meal is the other common test to evaluate the oesophagus.  This involves swallowing a thick paste of barium while taking X-rays.  The barium will coat the oesophagus and show abnormalities.  It is generally not very useful to demonstrate or diagnose reflux with barium meal studies.  A 24hr oesophageal pH study is the most sensitive test to diagnose GERD, where information can be obtained by nasal insertion of a catheter or simply ‘clipping’ a capsule to the lower oesophagus via an endoscopy.

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