You may think heartburn is simple, but it is not. There are multiple causes and getting a professional diagnostic work up will result in better treatment.

When your doctor has a complete, accurate description of your symptoms, and other causes of chest pain have been ruled out, the diagnosis may be heartburn (GER).  Heartburn can be treated using over-the-counter (OTC) medicines, prescription medicines, and lifestyle changes.  You'll find information about these when you go to Key Point 3.

However, if these treatments don't relieve the symptoms, or your doctor suspects GERD, one or more of the following diagnostic tests may be ordered:

Barium x-ray (also known as a barium swallow radiograph or esophagram).  For this test, you drink a chalky fluid that coats your esophagus and digestive system, enabling the x-rays to present a better picture of any problems or abnormalities, such as a hiatal hernia, ulcers, or stricture (narrowing of the esophagus), that may be causing difficulties.

Endoscopy (or upper endoscopy).  For this test, the doctor numbs your throat, sedates you slightly, then slides a thin, flexible, plastic tube with a tiny camera and light at the end (an endoscope) down your esophagus.  This gives the doctor direct images of the area that are more accurate than x-rays.  They can show any abnormalities, including ulcers, inflammation, tissue damage in the esophagus and stomach, hiatal hernia, etc.  (The test is technically known as esophagogastroduodenoscopy or EGD).

Biopsy, a test in which tissue samples are removed and then examined under a microscope to look for damage, infection and abnormal growths.  A biopsy can also test for precancerous cells in the esophagus (a condition called Barrett's esophagus) and esophageal cancer. 

Acid monitoring (also called pH monitoring, ambulatory acid probe, and ambulatory 24-hour pH probe).  For this test, the doctor numbs your throat, sedates you slightly, then slides a small tube (catheter) into your esophagus through your nose or mouth, then slides a tiny acid measuring probe through the catheter and attaches it to your esophagus, where it remains for 24 to 48 hours. You continue with your normal life while the probe measures how often and how much stomach acid backs up into your esophagus.  The measurements are recorded on a tiny, portable computer worn around your waist, and are later compared with standards to diagnose and understand your symptoms.  Another version of this test eliminates the catheter. Instead, the probe is attached to your esophagus during endoscopy, transmits measurements for about two days, then falls off the esophagus and passes out of you in your stool.

Esophageal impedance. This is similar to the acid monitoring test, but it measures the reflux of gas and fluids other than acid (such as bile) into the esophagus. 

Esophageal manometry.  For this test, the doctor numbs your throat, then slides a tiny, pressure-sensitive tube into your esophagus through your nose or mouth. You'll be asked to swallow.  When you do so, the muscles in your throat contract and exert pressure that is measured by tube. These are called measurements of motility (muscle contractions); the motility of the LES can also be measured.  These measurements help diagnose problems that may be linked to GERD.