[Diagnosis of gastro-esophageal reflux disease]

The diagnosis of gastro-esophageal reflux disease (GERD) predominantly relies on the patient's history and endoscopically visible alterations of the esophageal mucosa. Heartburn as the dominating symptom is highly suggestive of GERD though not specific whereas heartburn as one complaint among others is of limited value. Endoscopy enables the definite diagnosis of reflux esophagitis; however, the majority of patients (approximately 60%) does not exhibit erosions (non-erosive form of GERD). In these patients a short course of empiric PPI therapy gives valuable information about the presence or absence of GERD. Only those patients non-responsive to adequate PPI doses should undergo pH-metry. Other diagnostic investigation (e.g. manometry) should be restricted to selected cases.