Gastroesophageal reflux disease, or GERD, is a chronic health condition in which you experience recurring episodes of acid reflux. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), it’s a common condition, affecting an estimated 20 percent of people in the United States.

The main symptom of GERD is heartburn, a burning sensation due to stomach acid flowing back up into your esophagus. Another common symptom is regurgitation, in which stomach contents flow up into the throat or mouth.

An upper gastrointestinal (GI) endoscopy is a procedure that uses a thin, flexible tube with a camera to look inside of your upper GI tract. It can also be used to collect biopsies and perform procedures.

Upper GI endoscopy can be used in the diagnosis and, less commonly, the treatment of GERD. Below, we’ll go over these uses, what the endoscopy procedure is like, and what risks are associated with it.

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Illustration by Sophia Smith

Experiencing frequent heartburn or regurgitation often points to GERD. Because of this, a doctor may suspect GERD after reviewing your medical history and doing a physical examination.

If this is the case, they’ll start you on a proton pump inhibitor (PPI). PPIs treat GERD by lowering the production of stomach acid. A response to treatment with PPIs can confirm the diagnosis of GERD without further tests.

However, if you have less common or alarming symptoms, your doctor may want to order additional tests, such as an upper GI endoscopy, to see what’s causing them.

An upper GI endoscopy, also called an esophagogastroduodenoscopy, allows your doctor to examine the lining of your upper GI tract. This includes your esophagus, stomach, and the upper part of your small intestine (duodenum).

Doing an endoscopy allows your doctor to see if your symptoms are due to GERD, its complications, or another health condition. During the procedure, they may also collect a sample of tissue called a biopsy to analyze.

Other tests that might be used to diagnose GERD

In addition to an upper GI endoscopy, other tests can also be used to diagnose GERD or its complications. These include:

  • Ambulatory esophageal pH monitoring. This test uses a catheter or small capsule placed into your esophagus to track changes in pH, which can signal the presence of stomach acid. This information can indicate how different factors like diet and sleep relate to your symptoms.
  • Esophageal manometry. Esophageal manometry can help to find problems with your esophagus. It measures muscle contractions in your esophagus as you swallow. It can also evaluate the function of the lower esophageal sphincter (LES).
  • Barium swallow. A barium swallow helps detect narrowing of the esophagus or a hiatal hernia. You’ll swallow a chalky substance called barium, which coats your upper GI tract. A series of X-rays will then be taken to look at these tissues.

Doctors typically treat GERD using a combination of medications and lifestyle changes. Medications include PPIs and H2 receptor blockers.

However, there are some situations in which your doctor may recommend surgery, such as when:

  • Medications and lifestyle changes aren’t effective at managing your GERD symptoms.
  • Medications for GERD cause significant side effects.
  • You wish to stop using medications long term to treat GERD.

The most readily performed surgeries for GERD are fundoplication and Linx surgery.

One newer endoscopy-based surgical technique for GERD is called transoral incisionless fundoplication (TIF). This procedure involves an endoscopy. The Food and Drug Administration (FDA) approved TIF in 2007, and as of 2016, over 17,000 procedures had been completed.

The goal of TIF is to tighten the LES, which is the muscular valve connecting the esophagus and stomach. In some people with GERD, the LES is weakened and may open when it shouldn’t. This allows stomach acid to flow back up into the esophagus.

In TIF, an endoscopic device called EsophyX is passed through the mouth and into the stomach. Once in position, it’s used to fold the upper part of the stomach up against the lower part of the esophagus.

According to a 2016 review, the device then places a series of about 20 polypropylene fasteners, which are similar to stitches, in order to secure the area. The result is a tightened LES.

A 2021 review included 8 studies and looked into the outcomes of TIF over an average follow-up period of about 5 years. It found that:

  • Reported satisfaction was 12.3 percent before TIF and 70.6 percent afterward.
  • The rates of PPI use decreased after TIF, with 53.8 percent of people off of them completely and 75.8 percent using them only occasionally.
  • Most people reported an improved quality of life and reduced GERD symptoms during the follow-up period.

If your doctor orders an upper GI endoscopy to diagnose GERD, you’ll need to do a few things in order to prepare.

  • Have a conversation with your doctor. Be sure to let your doctor know about any medications, vitamins, or herbal supplements you’re taking and whether you have any medication allergies.
  • Adjust or stop medications. While you can take most medications as directed before your procedure, your doctor may instruct you to temporarily adjust or stop certain medications, such as:
  • Fast. In order to get the best view of your upper GI tract, your doctor will request that you not eat or drink anything for 6 to 8 hours before your endoscopy, according to the American College of Gastroenterology. Having a small sip of water to take medications is generally allowed, though.
  • Arrange for a ride. Sedatives will be used during the endoscopy, which means that it isn’t safe for you to drive afterward. Be sure to arrange for help getting home after your procedure.

Your doctor will give you more specific instructions on how to prepare for your procedure. Be sure to follow these carefully. If you have any questions or concerns, be sure to raise them as well.

An upper GI endoscopy is an outpatient procedure, which means that you get to go home the same day. It’s typically performed at a hospital or another outpatient medical center.

When you arrive, you’ll be asked to change into a hospital gown and remove any jewelry. A healthcare professional will check vital signs like heart rate, blood pressure, and blood oxygen and place an intravenous (IV) line into your arm or hand.

The upper GI endoscopy procedure itself is rather quick. The NIDDK says it often takes between 15 and 30 minutes. It typically involves the following steps:

  1. Your doctor will ask you to lie down on your side on the exam table.
  2. In order to help you relax, you’ll be given a sedative via the IV. You may also receive a numbing medication for your mouth or throat and a mouthguard to protect your teeth as well as the endoscope.
  3. The endoscope will be passed into your mouth and through your upper GI tract, which includes your esophagus, stomach, and duodenum. You may feel some pressure or discomfort as this is happening, but it shouldn’t be painful.
  4. During this time, the camera on the endoscope will provide video of the lining of your upper GI tract. The endoscope will blow out a little bit of air in order to get a better view.
  5. At any point in the procedure, your doctor may choose to take a biopsy to examine later in a laboratory.
  6. At the end of the procedure, your doctor will carefully remove the endoscope.

After the endoscopy is complete, you’ll be taken to a recovery room where you’ll be monitored for about 1 to 2 hours as the effects of the sedative wear off. You’ll then be able to return home.

When you leave the medical facility, you’ll get instructions on how to care for yourself at home. Make sure to follow these instructions carefully and ask questions if you have them.

The numbing medication used during your endoscopy inhibits your gag reflex. To lower the risk of choking, you’ll be instructed not to eat or drink anything until this medication wears off and you can swallow as usual again.

Having bloating or cramping for a short time is typical. This is due to the air that’s blown through the endoscope during the procedure. You may also have a sore throat due to the endoscope, but this typically only lasts for a couple of days.

When the results of your endoscopy are ready, your doctor will want to go over them with you. Your results may be available the same day as your procedure. If not, your doctor will contact you at a later date to discuss them.

Not everyone with GERD will need to have an endoscopy. As mentioned earlier, if common symptoms like heartburn and regurgitation respond to treatment with PPIs, this is often enough to diagnose GERD.

However, your doctor may order an upper GI endoscopy as a part of the diagnostic process if you’re experiencing symptoms that aren’t typical for GERD or are concerning.

Some examples of such symptoms include things like:

Risks related to an upper GI endoscopy are rare and happen in less than 2 percent of people. The potential risks include:

Risks typically happen within the first 24 hours after the procedure. Get medical care right away if you develop symptoms like:

  • a sore throat that doesn’t go away or gets worse
  • difficulty swallowing
  • trouble breathing
  • chest pain
  • worsening pain in your abdomen
  • vomiting, especially if it contains blood
  • blood in your stool
  • fever, with or without chills

Upper GI endoscopy can help your doctor diagnose GERD. While it’s not ordered in all cases, it may be necessary if you have atypical or alarming symptoms like trouble swallowing or chest pain.

Endoscopy, such as through the TIF procedure, can also be used to treat GERD. However, this is still uncommon. Generally, surgery is only recommended when other treatments haven’t been effective or cannot be used.

An upper GI endoscopy is an outpatient procedure with very few risks. To make sure your procedure goes smoothly, be sure to carefully follow all of your doctor’s preparation and aftercare instructions.