From the Guidelines
Diagnosis of GORD should be based on a combination of clinical assessment, symptom evaluation, and objective testing, with 24-hour pH monitoring being the gold standard diagnostic test, as recommended by the most recent guidelines 1. The diagnosis of GORD typically begins with a thorough clinical assessment of symptoms such as heartburn, regurgitation, chest pain, and difficulty swallowing.
- For patients with typical symptoms and no alarm features, empiric treatment with a proton pump inhibitor (PPI) like omeprazole 20mg once daily before breakfast for 4-8 weeks can serve as both treatment and diagnostic test.
- If symptoms improve with PPI therapy, this supports a GORD diagnosis.
- For patients with persistent symptoms despite treatment, or those with alarm symptoms (weight loss, dysphagia, anemia, vomiting), further investigation is necessary. Upper endoscopy (esophagogastroduodenoscopy) can identify esophagitis, Barrett's esophagus, or other complications, and should always be performed to rule out GERD complications 1. Barium swallow studies may help identify anatomical abnormalities like hiatal hernias, and are necessary before surgical treatment of GERD to identify hiatus hernia, strictures or a short oesophagus 1. The most recent and highest quality study recommends that a correct diagnosis of GERD is mandatory before intensifying medical therapy or planning surgery, and that MII-pH monitoring over 24h is the best available tool for the diagnosis of GERD 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Diagnosis of GORD
- Gastro-oesophageal reflux disease (GORD) is defined as a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications 2.
- The diagnosis of GORD can be challenging, as many patients with GORD complications such as oesophagitis, and up to a third of patients with Barrett's oesophagus have no reflux or heartburn symptoms 2.
- Conversely, patients can be symptomatic even when normal reflux levels are found and there is an absence of mucosal damage 2.
Symptoms of GORD
- Significant GORD symptoms occur at least once a week in 8.8-26% of Europeans, with equal prevalence of symptoms in men and women 2.
- The frequency and severity of symptoms do not accurately predict the degree of oesophageal damage 2.
- Symptoms of GORD occur in more than 45% of patients with asthma, and erosive oesophagitis on endoscopy has a 50% higher likelihood of a diagnosis of asthma 2.
Risk Factors for GORD
- GORD is a risk factor for Barrett's oesophagus and oesophageal adenocarcinoma, with the risk increasing with duration, severity and frequency 2.
- Abdominal obesity causes GORD by elevating intra-abdominal pressure, which promotes reflux and the development of hiatus hernia 2.
- Smoking cessation and weight loss are beneficial in reducing GORD symptoms, with GORD symptoms increased by 70% among daily smokers who have been smoking for more than 20 years 2.
Treatment of GORD
- Proton pump inhibitors (PPIs) are effective in the empirical treatment of complaints likely to originate from GORD and in treatment of endoscopy negative reflux disease (ENRD) 3, 4.
- PPIs are superior to H2-receptor antagonists (H2RAs) in empirical treatment of typical GORD symptoms 3, 4.
- The use of PPIs, H2RAs, and prokinetics in the treatment of GORD has been evaluated in several studies, with PPIs showing the greatest efficacy in relieving heartburn symptoms 3, 4.