Almost everyone has a case of heartburn every once in a while. But if you experience heartburn more than twice a week for an extended period of time, that’s known as GERD or gastroesophageal reflux disease.

When you eat food, it travels down the esophagus and ends up in the stomach. There is a muscle separating the esophagus from the stomach, known as the lower esophageal sphincter (LES), which closes during digestion preventing the acid in your stomach from rising or “refluxing” into the esophagus. People with GERD have a malfunctioning LES, which can either open sporadically or fail to close properly. This gives the acid in your stomach an opportunity to rise into the esophagus. When that stomach acid makes contact with your esophagus and throat, it causes irritation.

When to See a Doctor

Symptoms of heartburn include a burning in your chest and a sour taste in the back of your throat. That is the stomach acid making contact with the esophagus. This can be triggered by spicy foods or overeating. Occasional heartburn does not require a visit to the doctor. However, for someone who experiences heartburn on a consistent basis, two or three times a week, it is time to head to the physician’s office.

GERD in Disguise

GERD can sometimes be tough to diagnose because it has an ability to mask itself as other diseases. In some cases, GERD has other side effects besides heartburn. They can include a sore throat, trouble breathing, chronic cough, or more severe chest pain. Any one of these can be mistaken for a different disease, anything from asthma to a heart attack. Other times, GERD produces no symptoms making it completely silent.

Complete Diagnosis

It is possible for a doctor to diagnose GERD just by a description of symptoms without performing extensive tests. First, a doctor will ask about someone’s history of heartburn: how frequently it occurs, which symptoms appear, and if they are triggered by any specific foods. Before visiting the doctor, it may be helpful to keep a log of when heartburn occurs along with what meals were eaten.

If further investigation is needed, there are a number of tests that can help confirm GERD. 

Therapeutic Drug Trial

A doctor may recommend a therapeutic drug trial in an attempt to diagnose GERD. Proton pump inhibitors, or PPIs, diminish the amount of acid produced by the whole body by blocking pathways for acid stimulation. PPIs are taken for six to eight weeks and work for at least 75 percent of people with GERD. If the use of PPIs curbs the symptoms, it is a good indicator of GERD.

There are also prescriptions designed to strengthen the lower esophageal sphincter and move contents through the stomach. These are known as prokinetics. Unfortunately, they come with a number of side effects that prevent them from being 100 percent helpful.

Since GERD involves stomach acid in the esophagus, a good indicator of GERD is to test the amount of pH, or acid, in that area. An esophageal pH test places a small tube through the nose to the esophagus, just above the lower esophageal sphincter. The tip of the tube has a sensor that records the amount of acid in that area. The test usually lasts 24 to 48 hours and requires that you go about your daily business. To say the least, the test can be intrusive to daily activities, since it requires that you have a tube running from the nose to a recording device attached at the belt.

An endoscopy is excellent for confirming damage to the esophagus but is most effective when symptoms are moderate to severe. Only half of the patients with GERD will show symptoms on an endoscopy, because the damage has not progressed enough to be detected. During an endoscopy, a plastic tube equipped with a small light and camera is sent down the throat. The doctor is then able to examine the food passage closely for signs of abnormalities. Complications such as Barrett’s esophagus, a narrowed passageway, or esophagitis will be identified through an endoscopy.

During the endoscopy, a biopsy can also be performed. This is when a small piece of tissue is taken from the esophagus for a closer look under a microscope.

GERD has been associated with other conditions known as extra esophageal manifestations. Afflictions such as laryngitis, bronchitis, or pneumonia may cause your doctor to look at acid reflux activity. It is difficult to find a correlation between GERD and extra-esophageal manifestations though, because many people with manifestations do not necessarily have high levels of acid reflux. It is possible to be more sensitive to gastric acid, which can lead to any number of illnesses. 

For those with a higher sensitivity to acid, pH monitoring becomes unreliable for diagnosing GERD. But if proton-pump inhibitors are used and the symptoms of extra esophageal manifestations improve, it is easier to pinpoint GERD as the cause. If, however, proton-pump inhibitors are ineffective, chances are the doctor will search beyond GERD to diagnosis the condition.