Heartburn and acid regurgitation are typical of reflux – but they do not prove it. Similar symptoms can also have other causes. Before surgery, reflux disease must therefore be objectively proven and an oesophageal motility disorder ruled out. I decide together with you after the first consultation which tests you need; of course, I take existing results into account.
First consultation and examination
The first step is a detailed conversation about your symptoms, previous treatments and your goals, together with a physical examination. Please bring any existing results and a list of your medications.
Gastroscopy
Gastroscopy shows whether the oesophagus is inflamed, whether there is a hiatal hernia and whether there are changes such as Barrett’s oesophagus. Marked inflammation (grade B or higher in the Los Angeles classification) is in itself considered proof of reflux disease. I perform the gastroscopy myself, under brief sedation if you wish (more on gastroscopy, in German).
Barium swallow (video fluoroscopy)
During a barium swallow you drink a contrast medium while the swallowing process is filmed. The examination shows the anatomy of the junction between the oesophagus and the stomach, the size of a hiatal hernia and how food is transported through the oesophagus. It is performed by my radiology partner, Prof. Pokieser.
High-resolution manometry
Manometry uses a thin catheter inserted through the nose to measure the pressure and the muscle movement of the oesophagus during swallowing. It is important for ruling out conditions such as achalasia, in which a wrap would cause harm, and for planning the surgical technique. The test takes about 20 minutes.
24-hour pH monitoring or pH-impedance monitoring
A thin catheter inserted through the nose measures over 24 hours how often and for how long stomach contents flow back into the oesophagus. Conventional pH monitoring only detects acid reflux. pH-impedance monitoring additionally detects weakly acidic and non-acid reflux – that is, backflow that is hardly acidic, for example while taking acid suppressants or after meals. It is the most accurate method of proving abnormal reflux, especially when the gastroscopy is normal.
During the measurement you note down your symptoms. This makes it possible to check whether heartburn, regurgitation or coughing actually coincide in time with reflux episodes (symptom association). This is important for recognising reflux hypersensitivity – an oversensitive oesophagus with a normal amount of reflux – or functional heartburn. In reflux hypersensitivity the benefit of surgery is less certain; in functional heartburn surgery does not help. Acid suppressants usually have to be stopped for a few days before the measurement; I will tell you exactly how.
Manometry and pH monitoring are carried out at specialised centres in Vienna; I organise the appointments for you.
Who needs which test?
| Test | Purpose | Before surgery |
|---|---|---|
| Gastroscopy | Inflammation, hiatal hernia, Barrett’s oesophagus, ruling out other causes | always |
| Barium swallow | Anatomy, size of the hiatal hernia | always |
| Manometry | Motility of the oesophagus | often |
| pH monitoring / pH-impedance | objective proof of reflux | if reflux has not already been confirmed by other means |
Depending on the clinical question, further tests may be useful, such as a CT scan for very large hiatal hernias or an assessment of gastric emptying.
Medical content by Priv. Doz. Dr. Emanuel Sporn
Specialist in Surgery, Visceral Surgery and Vascular Surgery, former Associate Professor at the Department of Surgery, Vienna University Hospital. More about me
Last medically reviewed:
- Gyawali CP et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut 2024;73:361–371
- S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis (DGVS, AWMF-Register 021-013), 2023 (German S2k guideline on GERD and eosinophilic oesophagitis)
- Katz PO et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022;117:27–56
- Vakil N et al. The Montreal definition and classification of gastroesophageal reflux disease. Am J Gastroenterol 2006;101:1900–1920
This page is for information only and does not replace a personal medical examination and consultation.