Gastroesophageal Reflux Disease (GERD)

 Diagnosis History. If classic symptoms of heartburn and acid regurgitation dominate a patient’s history, then they can help establish the diagnosis of GERD with sufficiently high specificity, although sensitivity remains low compared to 24-hour pH monitoring. The presence of atypical symptoms (Table 1), although common, cannot sufficiently support the clinical diagnosis of GERD [B*]. Testing. No gold standard exists for the diagnosis of GERD [A*]. Although pH probe is accepted as the standard with a sensitivity of 85% and specificity of 95%, false positives and false negatives still exist [II B*]. Endoscopy lacks sensitivity in determining pathologic reflux but can identify complications (e.g. strictures, erosive esophagitis, Barrett’s esophagus) [I A]. Barium radiography has limited usefulness in the diagnosis of GERD and is not recommended [III B*]. Therapeutic trial. An empiric trial of anti-secretory therapy (AST) can identify patients with GERD who lack alarm/warning symptoms (Table 2) [I A*] and may be helpful in the evaluation of those with atypical manifestations of GERD, specifically non-cardiac chest pain (NCCP) [II B*].