A detailed history taking is vital to the diagnosis.
Useful investigations may include barium swallow X-rays, esophageal manometry, esophageal pH monitoring and Esophagogastroduodenoscopy (EGD). In general, an EGD is done when the patient does not respond well to treatment, has had symptoms or required medications for a prolonged time (generally 5 years), has dysphagia, anemia, blood in the stool (detected chemically), has weight loss, or has changes in the voice.
Esophagogastroduodenoscopy (EGD) (a form of endoscopy) involves the insertion of a thin scope through the mouth and throat into the esophagus and stomach (often while the patient is sedated) in order to assess the internal surface of the esophagus, stomach and duodenum.
Biopsies can be performed during gastroscopy and these may show:
Edema and basal hyperplasia (non-specific inflammatory changes)
Lymphocytic inflammation (non-specific)
Neutrophilic inflammation (usually either reflux or Helicobacter gastritis)
Eosinophilic inflammation (usually due to reflux)
Goblet cell intestinal metaplasia or Barretts esophagus.
Dysplasia or pre-cancer.
Rapid testing assays can quickly detect the presence of Helicobacter pylori in a biopsy sample through urease testing.