Main symptoms
The main symptoms appear mainly after meals or while lying down:
-
A burning sensation “rising” behind the sternum. Doctors talk about pyrosis.
-
Acid regurgitations, which give a sour taste in the mouth.
Reflux can also result in less common and more general symptoms:
-
A hoarse voice, especially in the morning
-
A chronic sore throat
-
Asthma that occurs at night and has nothing to do with an allergy.
-
Chronic cough or frequent hiccups
-
Nausea
-
Persistent bad breath
-
Dental problems (loss of tooth enamel)
Diagnosis
If symptoms are not improved with standard first line treatment with tablets, it may be something other than reflux. The next step is to see a gastroenterologist on the advice of the treating physician, for a Gastroscopy or OGD (Oesophago-Gastro-Duodenoscopy) after stopping treatment.
This allows you to see the lining of the oesophagus and stomach and if necessary to take biopsies. The specialist sometimes detects “eosinophilic oesophagitis”, an inflammation of the oesophagus linked not to reflux, but to infiltration of particular white blood cells. Similarly, this examination can quickly detect “peptic oesophagitis, stenosis, cancer or an endobrachy oesophagus”.
In cases of reflux, the gastrocopy is often normal, and does not confirm the “reflux”.
Gastroesophageal reflux reflux can be confirmed by an examination called pH-impedancemetry that measures the acidity of the oesophagus to confirm reflux. This test involves inserting a probe through the nose into the oesophagus. On the probe sensors collect the pH of the oesophagus and can differentiate pathological reflux from normal. It should be undertaken at least 7 days after stopping proton pump inhibitor (PPI) medication so that the results are not disrupted by the drugs.
If symptoms persist in a person with a history of oesophagitis or positive pHmetry without treatment, a repeat test under treatment may be proposed, which can differentiate between liquid, gaseous, acidic or non-acid reflux.
Finally it is important to detect motor disorders of the oesophagus by carrying out a swallow test, which shows the outline of the oesophagus and its movements after ingestion of an radio-opaque liquid. It can detect the contours of a hiatal hernia.
Other tests, such as manometry and “high-resolution manometry” allow further analysis of the movement of the oesophagus using intra-oesophageal sensors.
Some people have a functional disorder, visceral hypersensitivity (the lining of their oesosophagus is sensitive): they have normal endoscopy, normal acid exposure (pHmetry), a number of physiologicaly normal reflux episodes which are however symptomatic and match the results of the pH-impedancemetry.
