investigation

Last reviewed 01/2018

In practice a young patient with longstanding typical symptoms does not require investigation.

Investigation should be considered if the following features are present:

• atypical symptoms
• dysphagia
• short duration of symptoms in patient over 55 yr
• weight loss

The investigation of GORD consists of one, or a combination, of the following:

• endoscopy:
• the most common initial investigation
• can exclude other causes or dysphagia such as carcinoma
• is normal in up to 65% of cases

• symptoms requiring urgent referral of patients for endoscopy are (1):
  • gastrointestinal bleeding
  • iron deficiency anaemia
  • progressive unintentional weight loss
  • progressive difficulty swallowing
  • persistent vomiting
  • epigastric mass on palpation
  • suspicious barium meal result or other suspicious imaging result

• factors requiring consideration of referral of patients for endoscopy include (1) :
  • previous gastric ulcer
  • previous gastric surgery
  • non-steroidal anti-inflammatory drug use
  • pernicious anaemia
  • family history of gastric cancer

• barium radiology:
• may be used, particularly if a diagnosis of erosive oesophagitis is being considered

• 24 hour oesophageal pH monitoring:
• particularly useful if a link between symptoms and acid reflux needs establishing

Reference:

• (1) Mark Fox And Ian Forgacs. Gastro-Oesophageal Reflux Disease:Clinical Review.BMJ 2006; 332: 88 - 93