Heartburn Health Article

Diagnosis

Heartburn usually is diagnosed by patient histories, symptoms, and clinical assessments. Additional procedures may be used to confirm the diagnosis, assess damage to the esophagus, and monitor the healing progress. The following diagnostic procedures are appropriate for anyone with frequent, chronic, or difficult-to-treat heartburn, or complicating GERD symptoms as listed above.

Esophageal manometry uses a thin flexible catheter placed down the esophagus. Small openings in the catheter sense pressure at various points on the esophagus while the muscle is at rest and during swallowing. The pressures are transmitted to a computer that analyzes the wave patterns.

An upper gastrointestinal (GI) series, or "barium swallow," can reveal esophageal narrowing, ulcerations, tumors, hiatal hernia, or reflux episodes as they occur. X rays are taken after a patient swallows a barium (a chemical element) suspension. This procedure takes about 15 minutes. However, it cannot detect structural changes associated with different degrees of esophagitis.

Upper GI endoscopy uses a thin flexible tube to view the inside of the esophagus directly. It is performed by a gastroenterologist, a physician specializing in diagnosis and treatment of disorders of the gastrointestinal tract, or by a gastrointestinal endoscopist. Upper GI endoscopy enables the physician to distinguish the degree of esophagitis and provides an accurate profile of esophageal damage. This procedure may include a biopsy—the removal of a small piece of tissue—to examine for Barrett's syndrome or malignancies. Patients with Barrett's esophagus may have frequent examinations of the esophageal lining for early detection of precancerous cells.

Other diagnostic tests include measurements of esophageal acidity (pH), usually over a 24-hour period, using an ambulatory acid probe. The patient is given a large capsule containing an acid-sensing probe, a battery, and a transmitter. Acid in the esophagus is measured by the probe, which then transmits the information to a recorder that the patient is wearing on his belt.

Note: A burning sensation in the chest is usually heartburn and is not associated with the heart itself. About 15 percent of the annual six million U. S. emergency room visits for chest pain are due to heartburn. However, angina (one type of temporary chest pain, pressure, or discomfort) sometimes is mistaken for severe heartburn. Chest pain that radiates into the arms and is not accompanied by regurgitation is a warning sign of a possible serious heart problem. Persistent chest pain should always be evaluated by a physician.