If the patient suffers from heartburn then no investigation is needed providing that there is response to measures such as weight reduction, dietary advice and anti-acids, and the patient is under 40 years of age.
If heartburn does not respond to these measures, becomes more frequent, or the patient is older than 40 years, then investigation is required.
The first line investigation is upper GI endoscopy. This is the most sensitive means of diagnosing oesophagitis. However, in about 30% of patients with symptomatic gastro-oesophageal reflux there is no endoscopic abnormality. If the endoscopy confirms oesophagitis and excludes other pathologies then this gives a firm diagnosis. If the endoscopy reveals no abnormality but the symptoms are characteristic of reflux oesophagitis then medical treatment may still be initiated without further investigation.
If the symptoms are not characteristic of oesophageal reflux, or the response to medical treatment is inadequate, then 24-hour pH monitoring is indicated. A positive diagnosis of reflux oesophagitis is made if there is a pH of less than 4 for more than 5% of the time which correspond to episodes of heartburn.
Reference
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