As a pulmonologist, recognizing the contribution of GERD to asthma, chronic cough, or other lung diseases can be challenging. Endoscopy is not specific and only helpful if erosive disease is found. How can you tell if your patient is still refluxing despite being on acid suppressive medication? The tests listed below may be useful to you in this regard. Our testing capability has improved dramatically and patients can now be studied on or off acid suppressive medications and with or without nasal catheters.
- Impedance-pH monitoring (on acid suppressive medications) can demonstrate non-acid reflux.
- Catheter free pH monitoring (BRAVO) can demonstrate the degree and quantity of esophageal reflux in a 48 hour period without the discomfort of a catheter placed in the nose.
- Ambulatory pH monitoring can demonstrate the degree of reflux in multiple locations in the esophagus using a nasal catheter placed for a 24 hour period.
- High resolution esophageal manometry will reveal esophageal motility disorders such as achalasia or impaired esophageal clearance.
- Pharyngeal manometry may demonstrate cricopharyngeal discoordination or pharyngeal weakness.
- Fiberoptic endoscopic evaluation of swallowing test (FEEST) can reveal risk for aspiration in patients who cannot undergo modified barium swallows.