Oesophagus: Heartburn / Gastro-oesophageal reflux disease (GORD) Investigation
GORD is a disease of different facets. No single investigation is capable
of infallibly diagnosing the condition nor of assuring its relevance to
symptoms in an individual case.
Choice of clinical investigation depends on presentation, the
patient’s age, presence or absence of “alarm” symptoms (such as dysphagia or
weight loss), and the question to be answered. Thus, if the question is to
decide if mucosal injury is present, endoscopy or barium radiology is most
appropriate, whereas an acid perfusion test or 24 hour oesophageal pH
monitoring with observation of symptom-refluxassociation is the most useful
test in deciding if symptoms are due to oesophageal acid exposure.
Despite these considerations, in practice endoscopy is the most
commonly performed initial investigation, combining inspection of the
oesophagus with that of the stomach and duodenum to exclude other causes of
dyspepsia. In up to two thirds of patients, however, the results of endoscopy
are normal, particularly if patients are taking proton pump inhibitors or H2
antagonists at the time of investigation.
Therefore, in young patients with longstanding typical symptoms
(heartburn or pharyngeal acid regurgitation after meals and with postural
changes) no investigation is necessary. Atypical symptoms, dysphagia, or
presentation with short duration of symptoms in patients aged over 55 years
usually require investigation. There are no a priori grounds for diagnosis or
treatment of Helicobacter pylori infection in most patients, since there is no
evidence at present of an association.
Indeed, there is some evidence that eradication of infection, if
present, may actually make acid suppression with proton pump inhibitors more
difficult in GORD.
References:
Robert PH Logan. 2002. ABC OF THE UPPER GASTROINTESTINAL TRACT. London: BMJ Books
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Source: http://www.webmd.com/heartburn-gerd/guide/complications-untreated-gerd
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Oesophagus: Heartburn / Gastro-oesophageal reflux disease (GORD) Investigation
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