Diagnosis

A description of your symptoms and knowledge of your medical history is usually enough for your doctor to diagnose a reflux problem. But distinguishing between acid reflux and bile reflux is difficult and requires further testing.

You're also likely to have tests to check for damage to your esophagus and stomach, as well as for precancerous changes.

Tests may include:

• Endoscopy. A thin, flexible tube with a camera (endoscope) is passed down your throat. The endoscope can show bile, peptic ulcers or inflammation in your stomach and esophagus. Your doctor may also take tissue samples to test for Barrett's esophagus or esophageal cancer.

• Ambulatory acid tests. These tests use an acid-measuring probe to identify when, and for how long, acid refluxes into your esophagus. Ambulatory acid tests can help your doctor rule out acid reflux but not bile reflux.

  In one test, a thin, flexible tube (catheter) with a probe at the end is threaded through your nose into your esophagus. The probe measures the acid in your esophagus over a period of 24 hours.

  In another test called the Bravo test, the probe is attached to the lower portion of your esophagus during endoscopy and the catheter is removed.

• Esophageal impedance. This test measures whether gas or liquids reflux into the esophagus. It's helpful for people who regurgitate substances that aren't acidic (such as bile) and can't be detected by an acid probe. As in a standard probe test, esophageal impedance uses a probe that's placed into the esophagus with a catheter.