When you visit your GP or primary care provider with symptoms of reflux disease, such as heartburn, regurgitation and difficulty swallowing, you may be recommended to try medication or offered lifestyle advice such as changing your dietary habits.

Medication can include over-the-counter antacids and prescribed proton-pump inhibitors (PPIs) or H2-receptor antagonists (H2RAs).

But if symptoms are persistent, you may be advised to go for tests that aim to confirm or disprove the diagnosis of reflux disease – these are typically invasive diagnostic tests such as:

Upper Endoscopy
An upper endoscopy involves a light, flexible tube with a camera being orally inserted and passed into the oesophagus to see whether there is any damage to the lining of the oesophagus or stomach.

You may be given a local anaesthetic at the back of your throat and a sedative to help you relax.

The procedure, which typically takes between 15 and 30 minutes, can identify inflammation and is good for evaluating the presence of mucosal damage such as erosive oesophagitis and Barrett’s Oesophagus.

24-hour ambulatory pH monitoring
This test looks at the amount of stomach acid that refluxes from your stomach into the bottom part of your oesophagus over a 24-hour period.

An anaesthetic spray will be used to numb your nose and throat, before a tube is nasally inserted, passing down into the oesophagus where it sits just above the stomach for 24 hours. If test results indicate a sudden drop in your pH levels after eating, reflux disease is usually diagnosed.

24-h pHmetry/multichannel intraluminal impedance (MII)
Similar to ambulatory pH monitoring, reflux is detected by changes in intraluminal resistance (within the gastrointestinal tract), determined by the presence of liquid or gas inside the oesophagus and pH data is used to classify reflux as acid or non-acid

It can also measure the height of the gastric refluxate, so it can see if the reflux is coming up from the stomach to just the bottom part of your oesophagus or whether it also goes into your laryngopharynx.

High-resolution manometry
A narrow, flexible tube is passed through your nose, down the oesophagus, and into your stomach. Sensors on the tubing will measure the pressure levels of the lower oesophageal sphincter valve and the strength of the oesophagus.

During this 15 minute test, you will also be asked to drink water to evaluate how well the sphincter and muscles are working.

Wireless pH monitoring system Bravo

A miniature capsule is attached to the wall of the oesophagus during an upper endoscopy in order to identify the presence of acid reflux.

The capsule measures pH levels in the oesophagus and transmits readings wirelessly to a small recorder worn on a shoulder strap or waistband.

Pharyngeal pH test such as Restech 

A small catheter with a tiny sensor on the end is inserted through your nose and down the back of your throat to measure pH levels in the airways.

Fibre optic transnasal laryngoscopy

A flexible fibre optic tube is passed through the nose to examine the larynx and the throat and is performed by ENT specialists.
This test looks for swelling of the laryngeal tissues or changes to the appearance of the vocal

Barium Swallow
Once the barium moves down into your upper digestive system, a series of X-rays will be taken to identify any problems.
This involves swallowing a thick milkshake containing barium, which coats the inside of your throat, oesophagus and stomach.

Biopsy
Biopsies of the larynx can be used to detect biomarkers of reflux through methods called immunohistochemistry and Western  blot. Biomarkers can include proteins and enzymes.

The alternative…. Peptest!

Most of these tests are invasive and can cause discomfort or stress for many people.

Peptest is the world’s first non-invasive reflux diagnostic test – all you need to do is spit in a tube!