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Tests to Diagnose GERD | Stop Acid Reflux Now

Tests to Diagnose GERD

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Barium Swallow Radiograph
A barium swallow radiograph, commonly known as barium swallow, is an x-ray examination that evaluates the upper digestive tract (esophagus, stomach, small intestine), and is often used as a tool to diagnose GERD.  Since x-rays cannot pick up internal regions of the body, the patient is required to swallow barium.  Barium is a liquid that temporarily coats the esophagus, stomach and intestinal lining, allowing the outline of these organs to be visible on x-ray pictures.

At the start of the test the patient is required to drink barium.  Barium looks like a white milkshake but has a chalky flavor.  The patient may also be asked to swallow tablets that cause air bubbles to release in the stomach, which help doctors obtain a clearer picture of the internal organs.   Patients are asked to stand or lie in various positions over the course of a few minutes so that doctors can obtain x-ray pictures of all the internal structures.

Tips for test preparation:
- Inform your doctor and x-ray technician about any medical conditions or allergies you may have, if you are pregnant, or if you suspect pregnancy.
- You are usually advised not to eat or drink the night before your test, and check with your doctor to find out if you should stop any medication that you are currently taking.

Barium swallow is a very straightforward noninvasive test with no significant risks or side effects.  Patients are exposed to small amounts of radiation during the x-rays, but the exposure is minimal and is not likely to cause health problems.  Patients can normally expect the results of the test a day or two after the procedure.

The cost of the barium swallow radiograph procedure varies and will depend on where you have the test done.  However, the approximate cost ranges from  US$90 - $160.

Esophagel Manometry
Esophageal Manometry, sometimes simply called manometry, or referred to as an esophageal motility or functions study, is a test that measures the pressure in the esophagus.  This test is often recommended to determine if dysphagia (trouble swallowing) or heartburn is the result of muscles not properly working within the esophagus.

During the esophageal manometry test, the patient is hooked up to a manometer (a computer analyzer) via a thin pressure-sensitive tube that the patient swallows.  The tube is inserted through the nose or mouth down into the esophagus, where it remains to measure the effects of muscle contractions when the patient is instructed to swallow.  The tube features many openings that are designed to sense pressure in the various regions of the esophagus.  When the esophagus squeezes on the tube, the pressures that are detected are transmitted to the manometer that records the pressures on a moving graph paper.  Based on the wave patterns recorded by the esophageal manometry test, the doctor can determine if the results are normal or not.

Tips for test preparation:
- Inform your doctor about any medical conditions or allergies you may have, if you are pregnant, or if you suspect pregnancy.
- You will usually be instructed not to eat or drink anything during the eight hours before your test.
- Certain drugs, including caffeine and antacids, can affect the esophagus’ contractions.   Therefore, you need to check with your doctor to find out if there are medications you should refrain from taking 48 hours prior to the test.

The esophageal manometry test is a fairly simple procedure that usually takes less than an hour to perform.  Aside from a small amount of discomfort or possible gagging a patient may experience while swallowing the tube, the procedure is virtually painless and typically has no other side effects other than a slight sore throat which generally heals quickly.  Patients can resume all regular activities, eating and taking medications immediately after the test.  Results of the test are generally given to the patient once the test is complete or the doctor has had sufficient time to examine them.

The cost of the esophageal manometry test will vary depending on where you have it done, but on average the test costs approximately US$250.

Fecal Occult Blood Test
Fecal occult blood test (FOBT) is an examination of stool samples for the purpose of detecting occult blood (blood that cannot be seen by the naked eye) in what appears to be normal colored stool.  When a person experiences a slow bleed in their gastrointestinal tract, it does not necessarily change their stool color or appear as bright red blood.  So, a way of early detection of bleeding within the digestive system is to perform a FOBT and have the stool tested in a laboratory.

Fecal occult blood tests are commonly done to check for colorectal cancer, but are also frequently prescribed to check other gastrointestinal conditions that may cause blood to be passed in the stool such as GERD.

During a fecal occult blood test, three small stool samples are collected, usually on the end of an applicator, and samples are taken one day apart or as recommended by the doctor.   Once collected, stool samples are placed in a clean container and sent to a lab where they are evaluated.  During examination, the doctor may subject stool samples to chemical testing or examine them under a microscope.  The results of the test depend on the color the stool samples change.

Tips for test preparation:
- You may need to alter your diet 48 – 72 hours prior to the test.  Certain foods such as beets, carrots, radishes, grapefruit, red meat, etc. can alter test results so a special diet will need to be consumed as prescribed by your doctor.
- Inform your doctor of all medications you may be currently taking as some medications could affect the results.  Therefore, you may need to refrain from taking certain medications for 48 hours before the test.

The patient typically performs a FOBT themselves at home by purchasing fecal occult blood test kits at the pharmacy, or their doctor may perform the test using these home kits at an appointment.  To perform the test, patients simply follow the instructions in the kit.

Fecal occult blood tests are safe, easy to perform, and have no side effects.  Once the test is over, patients can return to their normal diets.  Results are usually given within a few days after the testing of the samples.

The cost of the FOBT is minimal and depends on the type of test kit that your doctor recommends you purchase.  The cost of newer FOBT kits, also called immuno-chemical tests, usually cost anywhere from US$25 - $50.  The older type of FOBT kits, also called guaiac tests, typically cost $5 - $10.

Bernstein Test
The Bernstein test, also known as an Acid Perfusion test, or the Esophageal Acid Infusion test, is an examination designed to diagnose GERD by determining if chest pain is the result of heartburn caused by acid in the esophagus, or if chest pain is related to a heart condition.  The purpose of the test is to reproduce symptoms of heartburn.

During the Bernstein test a thin tube is inserted in the patient’s nose and is slid down into the esophagus.  Once the tube is in place, mild hydrochloric acid (similar to stomach acid) is dripped through the tube into the esophagus and is followed by saline solution.  At this time if the patient experiences any pain or discomfort they are to tell the doctor or technician performing the test.  A sample of gastric contents is taken and removed to be analyzed at a lab.

Tips for test preparation:
- Inform your doctor about any medical conditions or allergies you may have, if you are pregnant, or if you suspect pregnancy.
- Do not eat or drink anything eight hours before your test.
- Certain drugs, such as antacids, can affect results.   Therefore, you need to check with your doctor to find out what medications you should refrain from taking 48 hours prior to the test.

The Bernstein test is a noninvasive and relatively short procedure.  The only discomfort or pain felt during the test occurs with the insertion of the tube (I.E. a risk of gagging or vomiting), and if you react to the acid and solutions poured into the tube.  However, all of these discomforts should ease when the test is over.  A sore throat may result as a side effect from swallowing the tube, but this normally goes away within hours.   Patients can go back to their regular diet, activities and medication after the procedure. Test results may be given to the patient within minutes of the procedure or a few days later.

The cost of the Bernstein test is approximately US$175 - $200, but cost will vary depending on where the test is performed.

Talk to your doctor before taking any tests – Make sure you know everything you need to know before taking a test or undergoing any procedure.  Talk to your doctor to find out what is required of you, and what you should expect before, during, and after the test.  It is vital you follow all your doctor’s instructions to ensure accurate test results.  Finally, be honest with your doctor and let him/her know of any concerns, or any health conditions you may have or medications you may be taking.

Are these tests covered by insurance?   It depends on your health insurance provider.  However, most major insurance companies (I.E. Medicare) should cover these tests.  Nevertheless, it is your responsibility to first check with your health insurance provider to learn what tests you are covered for, and if the coverage offered has limits.  Additionally, prior to taking any test, make sure you inform your insurance company and obtain authorization for the tests you will be undergoing.

To learn more about any of the tests mentioned above, be sure to talk with your doctor or gastroenterologist.

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