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How to diagnose acid reflux

This article was co-authored by Roy Nattiv, MD. Dr. Roy Nattiv is a board-certified Pediatric Gastroenterologist in Los Angeles, California. who specializes in a broad range of pediatric gastrointestinal and nutritional illnesses such as constipation, diarrhea, reflux, food allergies, poor weight gain, SIBO, IBD, and IBS. Dr. Nattiv received his undergrad degree from the University of California, Berkeley, and his medical degree (MD) from the Sackler School of Medicine in Tel Aviv, Israel. He completed his pediatric residency at the Children’s Hospital at Montefiore, Albert Einstein College of Medicine in New York, and his fellowship at the University of California, San Francisco (UCSF). While at UCSF, he was a California Institute of Regenerative Medicine (CIRM) fellowship trainee and was awarded the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Fellow to Faculty Award in Pediatric IBD Research. In addition to his clinical work, Dr. Nattiv is active in the research community and has been published in several high-impact medical journals.

There are 11 references cited in this article, which can be found at the bottom of the page.

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Acid reflux, also known as gastroesophageal reflux disease (GERD), is a common stomach problem that can happen to anyone and at any age. Your esophagus is the tube that connects your mouth and throat to your stomach. The foods and beverages you consume pass through your esophagus and into your stomach, then continue to work their way through your digestive tract. Sometimes, the muscle at the bottom of your esophagus does not work properly, which allows for stomach acid and food particles to find their way back up into your esophagus and throat area. This causes the symptoms associated with acid reflux or GERD. The only way to be certain that you have acid reflux is to see your doctor for an evaluation and diagnosis.

How do doctors diagnose GER & GERD?

In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing your symptoms and medical history. If your symptoms suggest you have GERD, your doctor may recommend treatment with medicines and lifestyle changes, instead of doing tests.

Your doctor may recommend medical tests if

  • your symptoms suggest you might have a complication of GERD
  • your symptoms suggest that you might have another health problem that causes symptoms similar to those of GERD
  • your symptoms don’t improve after treatment with medicines and lifestyle changes

Your doctor may refer you to a gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Your doctor may order one or more of the following tests to help diagnose GERD and check for GERD complications or other health problems.

Upper gastrointestinal (GI) endoscopy

Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a flexible tube with a camera—to see the lining of your upper GI tract, including your esophagus, stomach, and duodenum. During upper GI endoscopy, a doctor may obtain biopsies by passing an instrument through the endoscope to take small pieces of tissue from the lining of your esophagus. A pathologist will examine the tissue under a microscope. Doctors may order an upper GI endoscopy to check for complications of GERD or problems other than GERD that may be causing your symptoms.

How to diagnose acid refluxYour doctor may order an upper GI endoscopy to help diagnose GERD.

Esophageal pH monitoring

Esophageal pH monitoring is the most accurate way to detect stomach acid in the esophagus. Two types of esophageal pH monitoring are

  • catheter monitoring, in which a health care professional passes one end of a catheter—a thin, flexible tube—through your nose and into your esophagus to measure acid and nonacid reflux
  • capsule monitoring, in which a health care professional uses an endoscope to place a small, wireless capsule on the lining of your esophagus to measure acid reflux

During esophageal pH monitoring, you’ll wear a monitor that receives information from the catheter or capsule and tracks information about your diet, sleep, and symptoms. Your doctor will use this information to see how your diet, sleep, and symptoms relate to acid reflux in your esophagus. Doctors may order this test to confirm the diagnosis of GERD or to find out if GERD treatments are working.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

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Most people experience acid reflux, or heartburn, from time to time. But if you experience heartburn over the course of a few weeks, it could be a more serious type of acid reflux called GERD (gastroesophageal reflux disease). Left untreated, GERD can cause problems with the esophagus and breathing. If you’re concerned you may have acid reflux or GERD, talk with your doctor for an accurate diagnosis.

Acid Reflux Diagnosis

To diagnose acid reflux, your doctor will review your medical history and ask about your symptoms. Your doctor may suggest making some changes to your diet, lifestyle or medicines. If these treatments don’t help, you may need testing for GERD.

GERD Diagnosis

If your doctor suspects you may have GERD, he or she may recommend one or more tests to help diagnose it. In some cases, your doctor may use these tests to see whether GERD has caused any other health conditions, such as problems with your esophagus.

Tests to Diagnose GERD

Your doctor can use the results of these tests to find out whether you have GERD and decide the best type of treatment:

Upper gastrointestinal (GI) endoscopy. This test looks inside your digestive tract. Your doctor may recommend it if you have moderate to severe acid reflux. You can expect:

Before the test, you may get a sedative to help you relax and keep you comfortable during the test. You will also get an anesthetic to numb the back of your throat.

Your doctor places a small tube, called an endoscope, down your throat. A small camera at the end of the tube lets your doctor look for any problems caused by GERD.

Your doctor may also take a small piece of tissue from the lining of your esophagus, called a biopsy. This checks to see whether GERD has caused any problems in your esophagus.

Upper GI series. This test consists of a series of X-rays of your upper digestive tract. During the X-rays, you will drink a chalky liquid called barium. The barium coats the lining of your digestive tract so your doctor can see problems related to GERD, such as a narrowing in your esophagus, ulcers, or hiatal hernias.

Esophageal pH and impedance monitoring. This test measures how much acid is in your esophagus as you go through a normal day. For this test:

Your doctor places a tube through your mouth and into your esophagus. The upper part of the tube gets taped to your cheek and is left there for 24 hours.

A sensor at the bottom of the tube monitors how much acid comes into your esophagus. A monitor records the readings from the sensor.

Your doctor may also ask you to keep a diary of the types of foods you eat and your GERD symptoms to see how different foods and the time of day affect the acid.

Your doctor removes the tube after 24 hours.

Wireless esophageal pH monitoring. This test is another way to measure how much acid is in your esophagus:

During an upper GI endoscopy, your doctor places a small capsule on the wall of your esophagus. The capsule is about the size of a pencil eraser. It has a pH sensor, battery, and a transmitter. The capsule records the pH levels in your esophagus and sends the information to a small receiver you wear on a belt.

When you have symptoms of GERD, you press a small button on the receiver.

Your doctor may also ask you to record some of your daily activities, such as when you eat and drink, lie down, and get up.

Most people wear the monitor for about 48 hours. The capsule will detach on its own and pass through your digestive system.

Esophageal manometry. This test measures muscle movement in your esophagus. It can be done right in your doctor’s office:

Your doctor sprays an anesthetic on the back of your throat to numb the area.

A thin tube passes through your nose and into your esophagus.

A computer will measure how strong the muscle contractions are in different areas of your esophagus.

This test can tell whether your GERD is due to a weak muscle connecting your esophagus to your stomach or whether you have other esophagus problems.
If you have GERD, your doctor will likely recommend diet and lifestyle changes as the first step towards managing the condition. You may also benefit from medicines that control the amount of acid in your stomach or the movement of your upper GI tract, respectively.

How do doctors diagnose GER and GERD in children?

In most cases, doctors diagnose gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by reviewing a child’s symptoms and medical history. If symptoms suggest GERD, doctors may recommend treatment with lifestyle changes or medicines, instead of doing tests.

Doctors may recommend medical tests if symptoms suggest that a child may have a health problem other than GERD or a complication of GERD. Doctors may also recommend tests if symptoms don’t improve with lifestyle changes or medicines.

Doctors may refer a child to a pediatric gastroenterologist to diagnose and treat GERD.

What tests do doctors use to diagnose GERD?

Doctors may order one or more of the following tests to help diagnose GERD and check for other health problems.

Upper gastrointestinal (GI) endoscopy

Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a flexible tube with a camera—to see the lining of the upper GI tract, including the esophagus, stomach, and duodenum. During upper GI endoscopy, a doctor may obtain biopsies by passing an instrument through the endoscope to take small pieces of tissue from the lining of the esophagus. A pathologist will examine the tissue under a microscope. Doctors may order an upper GI endoscopy to check for problems other than GERD or complications of GERD.

Esophageal pH monitoring

Esophageal pH monitoring is the most accurate way to detect stomach acid in the esophagus. Two types of esophageal pH monitoring are

  • catheter monitoring, in which a health care professional passes one end of a catheter—a thin, flexible tube—through the nose and into the esophagus to measure acid reflux. Health care professionals sometimes combine this test with an impedance monitoring test, which can detect nonacid reflux, during the same procedure.
  • capsule monitoring, in which a health care professional uses an endoscope to place a small, wireless capsule on the lining of the esophagus to measure acid reflux.

The child wears a monitor that receives information from the catheter or capsule. During esophageal pH monitoring, a parent or caregiver tracks information about the child’s diet, sleep, and symptoms. The doctor uses this information to see how diet, sleep, and symptoms relate to reflux in the esophagus. Doctors may order this test to confirm the diagnosis of GERD or to find out if GERD treatments are working.

Upper GI series

An upper GI series is a procedure in which a doctor uses x-rays and a chalky liquid called barium to view the upper GI tract. Doctors may order this test to check for problems, such as anatomic problems in the upper GI tract, that may be causing or worsening symptoms.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

Acid reflux is a standard digestive condition the many people experience. The reason behind the occurrence of acid reflux is due to gastro esophageal reflux disease, which is a long term gastrointestinal illness. The presence of gastro esophageal reflux disease is due to the backwash of acids produced in the stomach into the esophagus tube. As the acid must enter the esophagus tube, they irritate and create burning sensation, known as heartburn.

Before proceeding with the tests and diagnosis for acid reflux, it is crucial to understand the signs that an individual experience. The following are the common symptoms that person experiences who is suffering from acid reflux:

  • Burning pain in the chest
  • Sour taste
  • Pain in the chest
  • Problem in swallowing food
  • A dry cough that is persistent
  • Hoarseness
  • Sensation of lump in the throat.

When to See a Doctor for Acid Reflux?

It is imperative to seek quick medical attention if you are suffering from a high degree of chest pain. You can also visit the doctor if you are showing additional signs such as shortness of breath, arm, and jaw pain. These signs may be the symptoms of a heart attack.

How Do You Diagnose Acid Reflux?

As stated in the above paragraph, depending on the symptoms experienced by the patient, the doctor decides on the tests for acid reflux that will provide in-depth information. The following is the list of tests that a gastroenterologist performs based on the symptoms and frequency of acid reflux occurrence:

Ambulatory Acid Test for Diagnosing Acid Reflux

Ambulatory acid probe test for diagnosing acid reflux, measures the pH content in the esophagus tube. The test requires the patient to undergo a 24-hour observation during which the doctor will receive in-depth analysis about the acid content in the esophagus tube. The acid probe test is capable of identifying when and for how long the stomach backwash is the acid into the esophagus. One type of monitoring the activity is by inserting a flexible tube through the nose into the esophagus. The other side of the tube connects to a device and a computer. The other type requires placing a clip in the esophagus using endoscopy. The clip transmits a signal continuously for about two days. The clip will fall off through the stool automatically.

X-ray of the Upper Part of Digestive System is also Conducted to Diagnose Acid Reflux

Barium swallow/GI series is a procedure where the patient drinks a chalky liquid that fills the lining of the gastrointestinal tract for diagnosing acid reflux. The doctor will prescribe x-ray for the upper part of the digestive tract. The result of the x-ray gives detail in the silhouette of the stomach, esophagus, & upper part of the intestine.

Endoscope Exam for Acid Reflux

For diagnosing acid reflux, the doctor will inject a flexible tube into the esophagus to visually check and look for the signs of damage occurred to the esophagus tube. The tube consists of a camera and light that will provide a clear view of the throat. It is also possible for the doctor to collect a sample of that tissue to perform further testing. Endoscopy is useful in looking at extreme acid reflux complications such as Barrett’s esophagus.

Another Way to Diagnose Acid Reflux is by Manometry Test

Manometry is esophageal motility testing for diagnosing acid reflux, which measures the pressure and movement in the esophagus. The test uses a catheter as the device that enters into the esophagus through the nose.

Treatment for Acid Reflux

Depending on the symptoms and the results displayed by the tests carried out by the doctor for acid reflux, he or she will offer a treatment consisting of both natural and medical attention. Natural care requires a change in the lifestyle and food habits, while the medical care for acid reflux requires the use of drugs for a particular period. It is also crucial to talk about the changes to the doctor to ensure that the changes are functioning appropriately.

This article does not provide medical advice. See disclaimer

There are a number of ways in which GERD can be diagnosed. Diagnosis is quite a complex procedure. When diagnosing for GERD, it is important to ensure that symptoms are purely due to GERD and not any other underlying problem. Sometimes some other conditions are mistaken as Acid Reflux condition.

How to diagnose acid reflux

Heartburn

One of the most common symptoms of GERD is heartburn. Heartburn is caused due to acid reflux which is usually formed after meals, due to a number of reasons. Patients complaining of heartburn are prescribed drugs that help to neutralize the excess acid in the stomach. This is often used to diagnose Acid Reflux condition and is known as a therapeutic trial. In case the patient finds relief from heartburn by taking the prescribed drugs, he is a confirmed GERD. Well, this method is not a completely accurate method of diagnosing GERD. Sometimes more serious conditions can have these symptoms.

Upper Gastrointestinal Endoscopy

One of the common ways of diagnosing GERD is by Upper Gastrointestinal Endoscopy. In this procedure, a small camera is inserted into the oesophagus. This helps to examine the internal organs like the oesophagus and stomach so that inflammation if any, can be detected. This method does not prove to be beneficial for many since the oesophagus looks normal in many patients suffering from GERD. In some patients, the inflammation is easily visible and the gastrointestinal endoscopy is helpful in diagnosing GERD. This endoscopic method is also helpful in identifying ulcers. If any ulcers are formed you may be advised for further diagnosis and immediate treatment. More serious problems like cancer can be seen and identified by gastrointestinal endoscopy. Hence this diagnostic method would be worth it, as it may reveal underlying problems if any.

Biopsies of the Oesophagus

In endoscopy, biopsies of the oesophagus taken can be helpful in diagnosing serious problems like cancers or other infections. Though this is in no way related to GERD, other life-threatening diseases can be identified.

Oesophageal Acid Testing

A method called oesophageal acid testing is the most effective way of diagnosing acid reflux condition. People suffering from GERD generally retain more amount of strong acid within their oesophagus. Oesophageal acid testing works on this principle. The tests are conducted to find the duration of retention of acid in the oesophagus. If the length is considerably longer, the patient is certain to have a GERD condition.

Tests on throat

ENT specialists also carry additional tests on the throat. A thorough check-up is done to find the cause of discomfort that can be acid reflux and GERD. Prescribing acid-suppressing medicines is also a part of the diagnosis of GERD. This is done to check if suppressing the acids can provide some relief.

The tests available to diagnose GERD are numerous. All the tests have different levels of accuracy. In some cases, a combination of diagnosis is performed to get more accurate results. This helps to ensure the patient is suffering due to acid reflux and not any other underlying serious disease.

Beverages like coffee and cold drinks are the main culprit which produces acids in large quantities when consumed on an empty stomach. The intestine lining secretes juices as well as the required acids, but when such food properties enter the intestine, then major conflicts arise. Acids have toxic contents; generate harsh effects and ultimately produces refluxes with food taste towards the esophagus. In case your water levels are low in your body or you have consumed spicy food all day, then it is likely that you will suffer from acid reflux after a period of 2 to 3 hours. When such periodic acid reflux starts and occurs frequently then it leads to heartburn or chest pain. It is important to immediately consult a GERD expert for treatment of acid reflux disease. However, there are some tests which can be done to diagnose the intensity or degree of acid reflux disease.

Diagnosis of Acid Reflux

In case you have been suffering from the symptoms of acid reflux every two to three days, then you must consult a doctor. Chronic regurgitation or heartburn is not good for the heart as well as lungs. Several complications come in notice after suffering from severe and regular acid reflux disease.

Generally, the doctor asks questions and medical history of the patient regarding the symptoms to diagnose acid reflux disease. For example, how often you feel chest pain and burning sensation in the stomach? Do you burp suddenly and get food reflux? Are you unable to sleep straight at night? When a patient says yes, to all the mentioned questions, then it is clear that GERD is somewhere settling its roots inside the stomach as well as esophagus. Possible tests and advanced diagnoses for the stage of the disease are necessary for treating acid reflux disease.

What are the Tests Done for Diagnosing Acid Reflux Disease?

There are some vital check-ups needed for diagnosis of acid reflux disease, but for chronic sufferers of GERD, advanced tests need to be done. Given below are the tests for diagnosis of acid reflux disease.

Esophageal pH Monitor Test for Diagnosing Acid Reflux Disease

This test is conducted on the patient to monitor the acidity or alkaline properties of a solution ascertained in the esophagus lining. The acids from the stomach which refluxes now and then are monitored for 24 to 48 hours and then diagnosis is considered. Esophageal pH monitor test determines the effectiveness of the drugs which were earlier given to the patient to prevent acid reflux disease. What is causing chest pain and episodes of acidic refluxes occurrence is measured through this test.

In Esophageal pH monitor test there is a thin plastic catheter passed through the nostril or mouth down towards the esophagus. It has to be swallowed by the patient gradually so that it can reach its destination. There is a sensor attached to the tip of the catheter which reacts when comes in contact with the acids in the esophagus.

Diagnosing Acid Reflux Disease with Bravo Capsule

A new technology is now used to test and diagnose GERD or Acid Reflux Disease which is called bravo capsule. This capsule consists of an acid sensing device, a transmitter and a battery. Levels of acids are monitored and transmitted through the sensor. Again a catheter is used to reach the esophagus and stomach entrance. The patient is asked to wear the belt around his or her waist. After the capsule is introduced into the throat, then catheter is attached to esophagus lining with the help of a clip. Now, capsule is attached and catheter is detached slowly. In this process patient doesn’t have to carry the catheter for 24 hours back to home. It is removed once capsule reaches the place. All the study is being conducted by the capsule within 24 hours of time and later in 5 to 6 days the capsule automatically passes away through the stool as it cannot be used again.

Diagnosis of Acid Reflux Disease with Endoscopy

This is another major test conducted on a patient who is suffering from acid reflux disease. A flexible tube is attached with a camera on its head which is passed inside the esophagus. The doctor on the monitor screen takes pictures of the esophagus as well as the stomach to know the exact condition of the patient. This test is very significant for patients who are suspected to suffer from Barrett’s esophagus or abnormal growth in the throat. This entire test takes 2 to 3 minutes and at times may take a longer period if the acid reflux disease is acute.

Diagnosis of Acid Reflux Disease with Manometry Test

This is a type of test which is conducted to identify the problems with valve pressure and motility present in esophagus. The doctor conducts this test when they find the necessity to examine the lower esophageal valve. This is usually conducted when GERD surgery procedure is lined up.

Diagnosis of Acid Reflux Disease with BSR Test

Barium swallow radiograph is a test used to diagnose the exact condition of the acid reflux actions. This is a kind of x-ray procedure in which esophagus problems are examined deeply. Hence, this is a painless process where the patient is asked to swallow a solution called barium.

The Best Test for Diagnosing Acid Reflux Disease

Endoscopy:Out of three or four types of tests done in the world for acid reflux diagnosis, there is one sure shot test recommended by every doctor and that is Endoscopy. This is a painful procedure which may or may not leave scars in the esophageal lining. Some patients cannot swallow the flexible tube conveniently because of which they vomit or feel nauseous.

Final Thought on Acid Reflux Disease

The GERD or acid reflux disease in elders is more severe than young adults because they have fewer symptoms due to multiple health problems. Confusion in gas erosions, irregular bowel movements and diarrhea is sometimes confused with GERD and later it concludes to chronic acid reflux disease. In case, you are suffering from similar problems than immediately consult a specialist. Proper and prompt diagnosis of acid reflux disease goes a long way in treating and managing acid reflux disease, as if this condition is ignored, it can turn into something more serious.

This article does not provide medical advice. See disclaimer

How does a pediatrician diagnose reflux?

Table of Contents

How does a pediatrician diagnose reflux?

In most cases, a doctor diagnoses reflux by reviewing your baby’s symptoms and medical history. If the symptoms do not get better with feeding changes and anti-reflux medicines, your baby may need testing. Upper GI series, which looks at the shape of your baby’s upper GI (gastrointestinal) tract.

What is pediatric GERD?

It happens when stomach contents flow back up (reflux) into the food pipe (esophagus) and cause symptoms or problems. GERD is a more serious and long-lasting form of gastroesophageal reflux (GER). GER is common in babies under 2 years old. Most babies spit up a few times a day during their first 3 months.

How much reflux is normal?

It may be frequent (5 in 100 babies with reflux have 6 or more episodes a day). Reflux usually becomes less frequent with time. 90 in 100 babies won’t have reflux after 1 year of age. It’s normal for some babies to have reflux.

Why does my 7 year old have acid reflux?

In very young children, the cause of heartburn is usually an immature digestive tract. In older children, risks include being overweight, exposure to secondhand smoke, and eating certain types of foods (for example, spicy foods). Children with neurological conditions, such as cerebral palsy, are also at greater risk.

Where can I find a paediatrician in Brisbane?

She provides newborn services as a paediatrician at Mater Mothers’ Private Brisbane, and specialist private paediatric services from Paedicare’s rooms in the Salmon Building on Mater’s South Brisbane campus. Julie was born in Brisbane. She enjoys providing holistic care for babies, children, and their families.

What should a paediatrician do for a child with reflux?

The Paediatrician may go on to arrange a pH/impedance study, upper GI endoscopy or allergy testing. Calculate feed requirements, parents may be over feeding, e.g. approximate fluid requirement 100-120ml/kg/day every 3-6hrs (depending on age and whether weaned on to solids)

When to treat gastroesophageal reflux in newborns?

A full discussion of reflux in neonates and preterm infants is beyond the scope of this report. Guidelines have distinguished between manifestations of GERD in full-term infants (younger than 1 year) from those in children older than 1 year and adolescents.

When to refer a child to a pediatrician for GER?

A key issue is distinguishing between clinical manifestations of GER and GERD in term infants, children, and adolescents to identify patients who can be managed with conservative treatment by the pediatrician and to refer patients who require consultation with the gastroenterologist.

How to diagnose acid reflux

If you have been diagnosed with GERD or any other digestive issue, there are several GERD diagnostic tests that your doctor can recommend, among them the barium swallow. A barium swallow test can diagnose several conditions, but we want to focus on how it can help diagnose GERD. This blog discusses what a barium swallow is, what happens during it and what to expect from a barium swallow.

How to diagnose acid reflux

August is Gastroparesis Awareness Month; since this condition and its symptoms are often confused with GERD, the first step in understanding what gastroparesis might be is its differences from GERD (gastroesophageal reflux disease). Today we’re comparing gastroparesis vs. GERD so that you can better understand which one of these two conditions might be ailing you!

How to diagnose acid reflux

When it comes to treating GERD, there are several kinds of tests that can be performed for a formal diagnosis. One of the most common of these procedures is known as an Upper Endoscopy. Let’s get to know this procedure, and how it can help you decide what to do next about your reflux.

How to diagnose acid reflux

How to diagnose acid reflux

For patients with recurring reflux attacks, daily life can be a struggle. If you have started the process of solving your reflux issues, your doctor has likely mentioned gastroesophageal reflux disease (GERD) to you. To diagnose you with GERD and rule out more severe afflictions, your reflux specialist will likely want to perform an esophageal manometry— one of four diagnosing tools that we have in our toolkit here at the Tampa Bay Reflux Center.

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More Articles

  1. Pain in the Esophagus After Eating
  2. Esophageal Erosion Symptoms
  3. Signs and Symptoms of a Perforated Peptic Ulcer
  4. Signs & Symptoms of Liver Ulcers
  5. When Drinking Orange Juice, I Get Pain in My Upper Right Chest
  • Symptoms, Location and Timing
  • Physical Exam
  • Laboratory Testing
  • Other Tests
  • Warnings and Precautions

When your stomach hurts, everything you do is that much harder. The pain itself is distracting, as is worry over finding the cause. Acid reflux and ulcers are common ailments that can sometimes be confused, because both cause pain in the stomach area. While ulcers do not cause acid reflux, these conditions sometimes occur together. Doctors rely primarily on your symptoms and tests to diagnose acid reflux versus an ulcer. The causes and treatments for ulcers and acid reflux differ, so an accurate diagnosis is important to determine the best treatment.

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Symptoms, Location and Timing

Your symptoms, the site and character of your discomfort, and symptom timing are important factors your doctor will consider in differentiating acid reflux versus an ulcer. Burning pain behind the breastbone and possibly into the throat that occurs after meals points toward acid reflux. This discomfort often worsens when you lie down or bend over. Ulcer pain is commonly described as gnawing or boring discomfort located toward the bottom of the rib cage. Ulcer pain usually occurs on an empty stomach and is relieved by eating. Unintentional weight loss may point toward an ulcer, whereas difficulty swallowing or a chronic cough makes acid reflux more likely.

  • Your symptoms, the site and character of your discomfort, and symptom timing are important factors your doctor will consider in differentiating acid reflux versus an ulcer.
  • Ulcer pain is commonly described as gnawing or boring discomfort located toward the bottom of the rib cage.

Physical Exam

Pain in the Esophagus After Eating

Your doctor will perform a physical exam to help determine the source of your pain, which could be due to an ulcer, reflux or another problem. Paleness suggests anemia, which may indicate a bleeding ulcer. Yellowish discoloration of your skin, known as jaundice, points toward the liver rather than the stomach or esophagus as the culprit for abdominal pain. A mass felt in the abdomen might indicate a tumor. Mild to moderate tenderness confined to one area of the upper abdomen might indicate an ulcer. Severe, more diffuse abdominal tenderness suggests the possibility of an ulcer that has bored through the wall of the stomach or intestine — or another serious problem.

  • Your doctor will perform a physical exam to help determine the source of your pain, which could be due to an ulcer, reflux or another problem.
  • Severe, more diffuse abdominal tenderness suggests the possibility of an ulcer that has bored through the wall of the stomach or intestine — or another serious problem.

Laboratory Testing

Your doctor might request laboratory tests to assist with the diagnosis between acid reflux versus an ulcer. The presence of bacteria called Helicobacter pylori — the usual cause of an ulcer — can be detected with blood, breath or stool testing. A stool sample may be examined for blood, which could indicate a bleeding ulcer. Blood tests can also determine whether you are anemic, which could indicate ulcer-related blood loss. Blood work also provides your doctor with information regarding kidney and liver function, which may help rule out other potential causes of your pain.

  • Your doctor might request laboratory tests to assist with the diagnosis between acid reflux versus an ulcer.
  • Blood tests can also determine whether you are anemic, which could indicate ulcer-related blood loss.

Other Tests

Esophageal Erosion Symptoms

Endoscopy typically provides a definitive diagnosis to differentiate between acid reflux disease and an ulcer 3. The procedure involves passing a thin, flexible tube containing a camera through the mouth into the esophagus, stomach and first part of the small intestine, or duodenum. Your doctor can look for esophageal inflammation or erosion from acid reflux or ulcers — sores in the wall of the stomach or duodenum. Esophageal manometry may be performed if acid reflux is suspected. The test assesses the function of the esophageal muscles, including the band at the entrance to the stomach that normally prevents reflux. If your diagnosis is unclear, your doctor may recommend pH monitoring to measure esophageal acid levels.

  • Endoscopy typically provides a definitive diagnosis to differentiate between acid reflux disease and an ulcer 3.

Warnings and Precautions

Pain from either an ulcer or acid reflux can usually be treated fairly easily if diagnosed before complications develop. However, if you have signs of blood loss — such as vomiting blood, bloody or tarry stools and/or tiredness — it is important to see your doctor right away. Intense pain might indicate a perforated ulcer, which is serious and requires emergency medical attention. Because:

  • the symptoms of reflux or an ulcer are sometimes similar to those of a heart attack
  • call 911 if you experience unexplained chest pain that radiates into the neck
  • jaw or arm
  • especially if the pain is accompanied by shortness of breath
  • dizziness and/or sweating

This article was medically reviewed by Roy Nattiv, MD. Dr. Roy Nattiv is a board-certified Pediatric Gastroenterologist in Los Angeles, California. who specializes in a broad range of pediatric gastrointestinal and nutritional illnesses such as constipation, diarrhea, reflux, food allergies, poor weight gain, SIBO, IBD, and IBS. Dr. Nattiv received his undergrad degree from the University of California, Berkeley, and his medical degree (MD) from the Sackler School of Medicine in Tel Aviv, Israel. He completed his pediatric residency at the Children’s Hospital at Montefiore, Albert Einstein College of Medicine in New York, and his fellowship at the University of California, San Francisco (UCSF). While at UCSF, he was a California Institute of Regenerative Medicine (CIRM) fellowship trainee and was awarded the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Fellow to Faculty Award in Pediatric IBD Research. In addition to his clinical work, Dr. Nattiv is active in the research community and has been published in several high-impact medical journals.

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Laryngopharyngeal Reflux (LPR) is when the contents of your stomach (usually natural acids) move back up the esophagus and into your larynx or into your nasal airway. While LRP impacts many people, LRP often goes undiagnosed and untreated. By looking for common symptoms, consulting a medical professional, and learning about LRP, you’ll be better able to diagnose it. In the end, you’ll be able to take steps to minimize your occurrences of LRP.