What tests are required to investigate Reflux?

1. Gastroscopy of Endoscopy – This is when a camera is passed into the stomach under anaesthetic to examine the Oesophagus and stomach. It is often helpful to combine this with Biopsy.
2. More specialised tests such as Manometry and 24 hour pH studies may also be indicated in some cases (see below for further info)
3. Special X rays and scans to study the anatomy and how the stomach empties may also maybe required.

Changes to the overall approach to Reflux, what’s changed?

The main changes to the approach to management of Reflux (GORD) come from the new understanding of the major impact and the recognition of the “GUT- brain” connection.

In simple terms, the Gut and Brain communicate intimately, stress and other factors that affect the brain can manifest as symptoms related to the Gut. “Reflux type” symptoms are one of the many manifestations but are not necessarily originated in the Gut.

This is termed Functional Heartburn and is not related to acid or other digestive juices backing up into the Oesophagus, while this diagnosis is confirmed by elimination the main focus is to deal with the Brain “stress “that is the primary problem.

Once confirmed the treatment may be Cognitive behaviour therapy and other modalities.

What Specific tests can be done to confirm or rule out Reflux or GORD?

The test that is the Gold standard in diagnosing GORD is known as  “High resolution Manometry and 24 hour pH testing”.

Why are these tests done and how do they help in the diagnosis?

The diagnosis of Reflux (GORD) often may require you to undergo special tests. There are two very sensitive tests that are the best way of confirming the diagnosis.

They involve analysis of the both the function of the Oesophagus combined a 24 hour analysis of the Oesophagus to check for acid or other digestive juices backing up from the stomach.

How are the tests done?

Surgeons at LapSurgery Australia have undergone training in conducting the test and have spent time perfecting the technique by one on one contact with world experts in North Western Hospital in Chicago USA. The test involves ceasing of all antiacid medication for one week, followed by a visit to the office where the surgeon together with trained nurse practitioners will carefully explain how the test is carried out, followed by introduction of local anaesthetic to the nose and throat to allow the passage of a high tech catheter into the stomach.

Care series of water swallows are done. The Catheter is able to sense the pressure in the Oesophagus, or swallowing tube, and real time data is gathered on various aspects such as the anatomy, pressure waves of the swallowing process and state and relaxation of the “Valve”. This information is key to diagnosing various problems and issues related to reflux.

A second part to the test will then be carried out with removal of the pressure sensitive catheter and introduction of a finer, acid sensitive catheter. This has a special tip that is very sensitive to acid. Its parked at a location in the Oesophagus 5 cm above the junction with the stomach. It can sense any acid that finds its way past into the Oesophagus and a continuous record is made on a small computer attached to your waist. Any symptoms are also recorded on a diary and by pressing a button on the computer this provides the surgeon with a real time recording of what’s happening in your Oesophagus over 24 hours.

The test is an 24 hour recording and we encourage you to have as a normal day as possible. The catheter is removed the next day by the nurse practitioner.

Can I be asleep when I have the test?

Unfortunately, you have to be completely awake as the swallow reflex is lost when we are asleep and instructions to swallow, which is an involuntary step is not possible. Where patients are extremely anxious, the surgeon may advocate prior sedation medication to help with passage of the catheter, you discuss this with our team before the test.

Is the test uncomfortable?

The main discomfort is passage of the tube via the nose, local anaesthetic placed into the nose will assist but not completely rule out discomfort, once in place the tube is tolerable, the test takes approximately ten minutes to carry out.

Are the tests covered under Medicare?

Part of the costs are covered by Medicare, but there is an out-of-pocket cost which will be clearly explained prior and full informed consent will be provided to you well in advance of the procedure. The Out-of-pocket costs are there as the capital costs of the machine and catheter need to be borne by LapSurgery Australia.

When will results be available?

A full analysis will be carried out by the Surgeon who will carry out a follow up call to discuss the findings and make recommendations about options and diagnosis within one week.

Will the test help me manage my symptoms?

The test results are critical to confirming and or ruling out the diagnosis and further treatment can then be planned, the options will be outlined to you. They include medication, and or a reflux surgery in some cases, where the diagnosis is that your symptoms are not related to GORD as indicated by the test, further investigations and or exploring the possibility that the symptoms may be related to the Gut-Brain connection can be explored.

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