Acid Reflux (GORD) Investigation

ALSW offers the latest in diagnostic services for GORD. Patients are evaluated, based on their symptoms, and in some cases given tests such as endoscopy (oesophagoscopy), Barium swallow, oesophageal pH and manometry.
Upper Endoscopy

  • OesophagoscopyUsing an instrument called an endoscope, we can inspect the oesophageal lining and take samples of tissue that appears abnormal. This is mandatory in older patients to exclude cancer.
  • Barium SwallowAn X-ray test that outlines the oesophagus. It is helpful in excluding cancer or hiatus hernia and may demonstrate an oesophageal stricture.
  • Cardiac EvaluationPatients whose GORD symptoms include chest pain may also need an electrocardiogram (ECG) and an exercise stress test to rule out heart disease.
  • Oesophageal pH monitoringOesophageal pH remains to be the ’gold standard’ for diagnosis of GORD. A catheter is placed through the nose and into the oesophagus for 24 hours to measure acid concentration in the oesophagus.
  • Wireless pH monitoringImproves patient comfort during monitoring and allows monitoring gastroesophageal reflux over extended (i.e., 48 to 72 hours) periods of time. The information gathered by these systems is still limited to pH data only.
  • Oesophageal Manometry or Motility StudiesMeasures how tightly the LOS shuts, and determines abnormalities in oesophageal pressure and movement.
  • Combined multichannel intraluminal impedance (MII) and PhMII-pH represents a change in the reflux testing paradigm. Reflux is detected by changes in intraluminal resistance determined by the presence of liquid or gas inside the oesophagus, and pH data are used to classify reflux as acid or non-acid. Combined MII-pH is the preferred method of testing patients with persistent symptoms on acid suppressive therapy, as it can clarify whether symptoms are associated with acid or non-acid reflux or not associated with reflux.
Barretts Oesophagus

This photograph shows a removed oesophagus with in a patient with Barrett’s (the Salmon pink areas in the upper part of the specimen). Note the cancer (the polypoid area).

Complications of GORD

Stricture
This represents one of the end-stages of GORD and classically presents with dysphagia after a long history of heartburn and regurgitation.

Barrett’s Oesophagus
Barrett’s oesophagus is defined as the presence of columnar lined mucosa in the lower oesophagus (abnormal lining). Barrett’s represents the extreme end of GORD characterised by sphincter hypotension, oesophageal peristaltic failure, upright and supine acid reflux. Barrett’s oesophagus is an insensitive oesophagus and patients may not present until they develop a stricture, an oesophageal ulcer, or even a malignant tumour.