Conditions: Suspected Reflux

What is suspected reflux?

As implied by the term, suspected reflux is when the problems a person reports and the findings on exam make reflux the most likely explanation for the symptoms. Reflux symptoms vary from person to person and from time to time. These symptoms are non-specific, meaning for a given symptom (such as throat clearing, as an example) there are multiple potential conditions that might account for that problem. In assessing one or more potentially related symptoms, a physician will consider statistical prevalence of various conditions as well as the danger of these potential causes when formulating a diagnosis or short list of possible diagnoses and a plan for further investigation or treatment.

What is a trial of therapy for reflux?

When reflux is suspected, gathering information to support or refute this hypothesis may be undertaken in a variety of ways. Of these options, risk, discomfort, and resources are considerations a physician will incorporate into a recommendation. One safe, inexpensive, and easy first step toward better assessing for the presence of reflux is to undertake a short period of treatment for reflux and assessing the response.

For many patients, a one-month trial of a reflux medication (such as omeprazole 20 mg daily) as well as reasonably strict adherence to diet and lifestyle measures aimed at minimizing reflux may be recommended. As an additional effort to investigate reflux as a cause of the offending symptoms, one may then stop using medication for reflux and stop dietary and lifestyle efforts to curb reflux after the month trial, and then assess for worsening of symptoms.

How can someone track their reflux symptoms?

Since the symptoms of reflux may respond to medication and diet and lifestyle changes gradually over weeks, improvement in symptoms may not be sudden or striking. One way of assessing for improvement is to complete the reflux symptom index survey before a trial of therapy, then again at two, four, and six weeks afterwards.

How does one proceed after a trial of therapy for reflux?

The degree of improvement, if any, in symptoms after a trial of therapy for reflux may be sufficient for a more definitive diagnosis of reflux. If, for example, the symptoms of concern improve significantly during therapy, but then return after stopping therapy, these results may support the diagnosis adequately for a patient and their physician to move on to long-term management of reflux. Alternatively, if symptom improvement is weak or absent, then more definitive investigations for the cause of symptoms may be advised.

How is reflux diagnosed more definitively?

While there is not one perfect test for diagnosing reflux, the following list includes some procedures that may be diagnostically valuable:

• Barium swallow study (sometimes combined with a modified barium swallow study): This test consists of taking multiple x-rays during the swallowing process. In the radiology suite, food that has some barium in it is given to the patient. The barium, which tastes and feels a little chalky, allows the food bolus to show up well on the x-rays. Swallow study testing is often used when a patient’s symptoms include swallowing difficulty, as this testing may demonstrate any of a number of causes for swallowing problems. A barium swallow study may show reflux happening during the study, and visualizing this does confirm the presence of reflux. If reflux is not seen during the barium swallow study, this does not prove that reflux does not happen.

• Flexible fiberoptic laryngoscopy: This safe and quick visual examination of the throat is performed in an ENT office to inspect for conditions that may account for throat or voice symptoms. While reflux may cause some swelling and redness in the throat, this study cannot definitively prove reflux is present; rather, it helps rule out other conditions with overlapping symptoms.

• Esophagogastroduodenoscopy (EGD): Also known as an “upper GI scope,” this is a visual inspection of the esophagus, stomach, and upper part of the small bowel. This study may be combined with biopsies, which may diagnose a condition of severe chronic reflux called Barrett’s esophagitis. An EGD may show inflammation of the esophagus, which may support the diagnosis of reflux, but the absence of inflammation is considered by many not to be proof of the absence of reflux. An EGD may also demonstrate the presence of a hiatal hernia, which is known to promote reflux. An EGD may also identify problems other than reflux.

• 24 hour pH probe: A flexible tube containing one or more pH sensors can be routed from the nose, down the throat, and on to the esophagus, where it is left in place for 24 hours. During this time, the individual is advised to go about their normal everyday activities, so as to be representative. Some 24 hour pH probes also are used with a remote control button that the user can push whenever they feel symptoms. This time stamped data can then be compared to episodes of acid recorded in the esophagus.

• 24 hour impedance probe: This is very similar to the 24 hour pH probe, but the difference is that an impedance sensor may detect the presence of liquid, even if it is not acidic.