The diagnosis of gastroesophageal reflux disease.
BACKGROUND
Gastroesophageal reflux disease is a highly prevalent condition that imposes a significant economic impact on the US health care system. The utility of commonly used tests for the diagnosis of gastroesophageal reflux disease has not been adequately reviewed.


METHODS
A comprehensive review of the literature was undertaken to provide an evidence-based approach to the diagnosis of gastroesophageal reflux disease. EMBASE (1980-December 2008), OVID MEDLINE, and PubMed, (1966-December 2008) were searched using "gastroesophageal reflux" and "adults" with other terms, including medications, diagnostic tests, symptoms, and epidemiologic terms. Studies were limited to human trials, English language, and full articles.


RESULTS
Heartburn is a reasonably sensitive symptom for the diagnosis of gastroesophageal reflux disease, although it does not reliably predict esophagitis. Standardized questionnaires have limited specificity, whereas the double-contrast barium swallow has a low sensitivity to diagnose gastroesophageal reflux. The role of esophageal manometry is limited to accurate placement of a pH-measuring device. pH testing has reasonable sensitivity and specificity for the diagnosis of gastroesophageal reflux disease. The sensitivity of upper endoscopy to diagnose gastroesophageal reflux is lower than that of pH tests.


CONCLUSIONS
The diagnosis of gastroesophageal reflux disease remains difficult. In the absence of alarm symptoms, empiric treatment with acid suppression is warranted. pH testing provides valuable information in many patients, although the clinical utility of newer tests needs to be determined. Endoscopy should not be the first test used to diagnose gastroesophageal reflux.
Lacy
Brian E
BE
Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. brian.lacy@hitchcock.org
Weiser
Kirsten
K
Chertoff
Jocelyn
J
Fass
Ronnie
R
Pandolfino
John E
JE
Richter
Joel E
JE
Rothstein
Richard I
RI
Spangler
Chad
C
Vaezi
Michael F
MF
D000863:Antacids / Q000627:therapeutic use; D001464:Barium / Q000494:pharmacology; D003287:Contrast Media / Q000494:pharmacology; D004945:Esophagoscopy; D004947:Esophagus / Q000737:chemistry / Q000000981:diagnostic imaging; D019317:Evidence-Based Medicine; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008365:Manometry; D018670:Monitoring, Ambulatory; D011859:Radiography; D011795:Surveys and Questionnaires
D000863:Antacids; D003287:Contrast Media; D001464:Barium