Reflux Testing When Dietary Measures Fail
One of the most important things that we have to consider when faced with reflux disease that is not responding to simple dietary measures is what type of testing do we need to do to fully characterize that disease. On the surface that seems like a fairly simple concept, but unfortunately, because we’re dealing with the esophagus as well as the stomach and a number of sphincters that intervene in between, it’s important that we fully characterize the motility and the contents of those organs. This will provide a better idea of what’s really causing the reflux, what are the crucial outside influences, and what complications the reflux disease has created affecting other organs. Testing as a group may be divided into motility tests, tests of emptying , and pH testing. A typical test is the esophageal motility study, which provides a view how the upper esophageal sphincter works, how the lower esophageal sphincter works, and how does the body of the esophagus contract. Has reflux caused an abnormality or is there an abnormality that actually is contributing to the reflux. Another important study is going to be a pH study, which helps confirm exactly how much and to what location the reflux is taking place.
We know that there is alkaline type reflux, and acid type reflux, which can be divided into both weakly acid and strongly acid types. There is also the refluxing of digestive enzymes called pepsin in particular, which is very important when we talk about laryngeal reflux or LPR. In addition, because the stomach is involved in this entire reflux picture, we want to know does the stomach empty normally. We need to make sure that the stomach is either emptying normally or abnormally. Either way, we’ll be able to then judge how to better treat your reflux. And then the final test, which is very important, which is becoming more and more important these days, is something called the electrogastrogram. The electrogastrogram is something that will determine if the stomach contracts normally or if there perhaps an obstructive change contributing to the reflux, that if addressed first might make the reflux better. That is typically the full family of tests. Of course, you would undergo an upper endoscopy or perhaps a direct laryngoscopy to look more directly at the tissues to evaluate the damage. Do we have ulceration? Do we have inflammation? Are the vocal cords involved? These are some of the important questions that we’ll be looking at when we do your diagnostic evaluations.