Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnosis or to rule out complications
- Esophago-gastro-duodenoscopy (EGD; endoscopy of esophagus, stomach, and duodenum)* – for suspected Barrett’s esophagus as chromoendoscopy by applying acetic acid or methylene blue to the mucosa to detect dysplastic areas; targeted biopsy from all suspicious lesions (in Barrett’s esophagus additionally 4-quadrant biopsies); an inconspicuous finding does not exclude GERD Furthermore indicated (indicated) in case of: Dysphagia (difficulty swallowing), odynophagia (pain on swallowing), recurrent (“recurring”) vomiting, (involuntary) weight loss, anemia (anemia), evidence of gastrointestinal blood loss (gastrointestinal bleeding) or a mass
- Esophageal pre-swallow (administration of a water-soluble contrast agent to assess esophageal passage into the stomach and gastric emptying) – for suspected passenger disorders due to stenosis (narrowing) or stricture (high-grade constriction); indication: patients with recurrent vomiting and dysphagia (difficulty swallowing)
- Manometry – To determine if there is reduced lower esophageal sphincter (LES) pressure. Also measured is the esophageal peristalsis (“mobility of the esophagus”).
- 24-h pH-metry (acid measurement) – measures pH fluctuations in the esophagus. Advantageous here is the longer measurement time (“more physiological conditions”). The reflux index RI (% of time pH < 4) is assessed. If necessary, perform a 24-hour pH-metry-Mll (multicanal intraluminal impedance measurement). This also allows the recording of a slightly acidic or non-acidic reflux and additionally records the rising height of the reflux episodes. Indication (field of application): reflux symptoms (eg, heartburn) that do not respond to empirical PPI therapy (therapy with proton pump inhibitors; proton pump inhibitors).
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) – to rule out cardiac causes.
