Gastroesophageal Reflux Scan Health Article

Definition

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal problems among children or adults. It is defined as the movement of solid or liquid contents from the stomach into the esophagus. Gastrointestinal reflux imaging encompasses methods used to visualize and diagnose GERD.

Purpose

The purpose of gastroesophageal reflux scanning is to visualize the interior of the upper stomach and lower esophagus. Such inspections assist in making an accurate diagnosis and in planning appropriate treatment.

Precautions

For all tests used to evaluate GERD, persons must not have other medical complications such as high blood pressure, asthma, or esophageal varices. They should not be experiencing other acute medical conditions.

Description

A brief description of gastroesophageal reflux disease assists in understanding the scanning methods used. Gastroesophageal reflux disease is the term used to describe the symptoms and damage caused by the back-flow (reflux) of the contents of the stomach into the esophagus. Stomach contents are usually acidic. Because of their acidity, they have the potential to cause chemical burns in unprotected tissues such as those lining the esophagus.

Gastrointestinal reflux is common in the American population. Approximately one adult in three reports experiencing some occasional reflux, commonly referred to as heartburn. Approximately 10% of these persons experience reflux on a daily basis. Most persons have very mild disease. Occasionally, persons experience burning as a result of reflux. This is described as reflux esophagitis when it occurs in the esophagus.

There are several causes of gastroesophageal reflux. These include the following:

• Incompetent lower esophageal sphincter. When the muscular sphincter that is the boundary of the esophagus and stomach relaxes, reflux can occur. This is the most common cause for gastroesophageal reflux. Reflux usually occurs when persons bend, lift a weight, or strain. Persons with esophageal strictures or Barrett's esophagus are more likely to experience gastroesophageal reflux than are others.
• Acidic irritation. Gastric contents are acidic, with a pH less than 3.9. Such acid is very caustic to the lining of the esophagus. Repeated exposure to acidic gastric contents leads to scarring. If the exposure is sufficiently severe or prolonged, strictures can develop. Occasionally, pancreatic enzymes or bile reflux into the stomach and lower esophagus. These contents are extremely acidic (with a pH less than 2.0).
• Abnormal esophageal clearance. Acid reflux is washed away by saliva that is swallowed over the course of a day. During the night, swallowing is decreased. This results in a longer contact time between acidic stomach contents and the esophagus. The net result is a chemical injury. Sjögren's syndrome, radiation to the oral cavity, and some medications (anticholinergics) also decrease the flow of saliva and can result in chemical injury. Saliva also contains bicarbonate, which neutralizes some acid content. This, too, is diminished at night, contributing to nocturnal exposure and irritation over a period of time. Other medical conditions such as Raynaud's disease and scleroderma are often associated with abnormal esophageal clearance. Hiatal hernia is present in more than 90% or persons with erosive disease.
• Delayed gastric emptying. When gastric outflow is obstructed or gastric motility is impaired, gastric contents do not leave the stomach in a timely manner. This enhances the opportunity for gastric reflux.

Heartburn associated with gastroesophageal reflux occurs 30 to 60 minutes after eating. It also occurs when a person reclines. Most persons who experience gastroesophageal reflux can obtain relief with baking soda (Alka-Seltzer) or antacid tablets. This pattern is often sufficient for diagnostic purposes. Under these conditions, physical examination and laboratory findings are usually within normal limits.

Persons with complicated GERD, or those who do not respond to the usual remedies (baking soda or antacid tablets), require special examinations. There are several imaging methods used in the diagnosis of GERD. Details concerning each of the procedures follow.

Upper endoscopy

Endoscopy documents the condition of mucosa in the lower esophagus and upper stomach, evaluating the extent of GERD progression.

Ambulatory esophageal pH monitoring

Measurements of pH are used to evaluate the degree of GERD.

Barium esophagography

Barium esophagography can detect many abnormalities. including reflux.

Esophageal manometry

This documents the ability of the esophageal sphincter to close and keep stomach contents from refluxing.

Health care team roles

A family physician, pediatrician, internist, or cardiologist usually makes the initial diagnosis of GERD. A gastroenterologist usually performs the tests required for diagnosis. A radiology technologist performs the barium esophagography and a radiologist interprets it.