Diagnosis Options

Establishing the cause of your heartburn is the first step toward treatment. Our providers have experience in a variety of diagnostic tests, from the more common X-ray and endoscopy procedures to sophisticated impedance pH testing. Learn about some of them here:

Esophagram (X-ray of the esophagus and stomach)

Purpose: This test provides X-ray imaging of your esophagus and upper stomach, including the anatomy and motility of the esophagus. It is useful in evaluating swallowing problems, as well as reflux, and is frequently obtained to evaluate esophageal and gastric problems.

Description: An esophagram is performed in the X-ray (radiology) department. You will be given a chalky-tasting thick liquid (barium) to drink, and X-rays will be obtained as you swallow.

Risks: A barium swallow is generally a safe test. Allergic reactions to barium are very uncommon, but may occur. Constipation may result from the barium, and sometimes a mild laxative is helpful. Rarely, barium may be aspirated into the lungs during the test.

Preparation: There is no preparation needed for an esophagram.

Afterwards: There is no sedation, so you can drive yourself home.

Endoscopy – Esophagogastroduodenoscopy (EGD)

Purpose: An EGD provides a visual inspection of the esophagus, stomach and first part of the small bowel (duodenum). This procedure enables visualization of changes to your esophagus and stomach, such as ulcers, erosions and Barrett’s esophagus, as well as changes to the anatomy.

Description: The EGD is performed in the procedure center at any of our surgical locations. You will be sedated to make you relaxed and comfortable. The procedure is painless and takes approximately 15 to 30 minutes. You will go home the same day.

Risks: Having an EGD involves a small risk of complications including, but not limited to, sore throat, bleeding or perforation (puncture) of the upper gastrointestinal tract. Because of the intravenous sedation, there is a risk of problems with breathing, heart arrhythmias and pneumonia.


  • NO eating or drinking after midnight the night before the procedure.
  • You may take sips of water with your medication two hours before your procedure.
  • If your test is in the afternoon, you may not eat or drink anything for eight hours before your procedure.
  • You may need to stop blood thinners prior to the procedure. Ask your physician.

Afterwards: Because of the sedation, you will need a driver to take you home.

High Resolution Impedance Manometry (HRIM)

Purpose: High Resolution Impedance Manometry measures pressures and fluid movement in the esophagus. These measurements help us diagnose esophageal motility disorders and are crucial in planning esophageal surgery.

Description: The HRIM procedure is performed in the office. A small flexible catheter (tube) will be placed into your esophagus through your nose. You will be asked to swallow small amounts of salt water 10 to 12 times during the test. The test lasts about 15 to 20 minutes.

Risks: During the esophageal manometry procedure, there is a small potential for nose bleed. Some patients have difficulty with gagging, but with relaxation, most patients can complete the procedure.

Preparation: Your stomach needs to be empty, so you should have nothing to eat or drink for four hours prior to the study. If you are having other procedures, such as an EGD (endoscopy), you may be asked to avoid eating after midnight prior to your procedure.

Afterwards: There will be no sedation, so you may drive yourself to and from the appointment.

24-Hour Esophageal Impedance pH test

Purpose: The 24-Hour Esophageal Impedance pH test evaluates the extent of gastric reflux into your esophagus over a prolonged period of time, typically 24 hours. Sensors on a catheter measure the level of acidity at various levels in your esophagus, as well as the reflux of stomach contents up into the esophagus. It is the most accurate test to document gastroesophageal reflux and is generally our preferred test because it measures acidity at different levels as well as non-acid reflux events.

Description: In the Esophageal Impedance pH test, a small catheter (tube) will be placed into your esophagus through your nose. This catheter is very thin (2mm in diameter) and is connected to a pocket-sized recording device that will hang over your shoulder. The catheter is inserted during an office visit. After you leave our office, you should go about as much normal activity as you can for the 24-hour duration of the test. The tube is connected to a small receiver, so you may not shower during the study. You will need to return to the office the following day (24 hours later) to have the tube removed.

Risks: Patients may experience some irritation and discomfort in the back of their throat during the procedure. More than 90 percent of patients are able to complete the procedure. Rarely, refractory stimulation of the gag reflex may prohibit completion.

Alternatives: In some patients who are unable to complete the test, or in whom more prolonged monitoring is thought to be more beneficial, the Bravo capsule pH test is an alternative.


  • The most accurate results of this test are obtained if you have been off your reflux medication (such as Prilosec, Prevacid or Dexilant) for seven days.
  • You may take Pepcid, Zantac or Tagamet up until two days before the test.
  • You may take Tums, Mylanta or Gaviscon up until six hours before the procedure.
  • During the test, please do not take any antacid medications until the tube comes out. Once the tube is out, you may return to your regular medications.
  • The receiver is attached to the catheter and cannot get wet. This means you cannot shower until the tube is removed the following day. The catheter is visible and will be taped to your nose for the duration of the test.

Bravo™ Capsule Esophageal pH Test

Purpose: The Bravo Capsule Esophageal pH Test measures and records the level of acidity (pH) in your esophagus to determine the degree to which you have acid reflux over a 48 to 96-hour period. The Bravo device consists of a capsule about the size of a vitamin pill that attaches to your esophagus and transmits information wirelessly to a pocket-sized receiver that you carry with you.

Description: The capsule will be put in place with a catheter. The capsule attaches itself to the inside of your esophagus using suction, and the introducing catheter is then removed. The Bravo usually is placed during an endoscopy procedure while you are under sedation. The receiver is returned to our office after completion of the test. The capsule will dislodge itself in about 3 to 7 days and pass out with the stool. The capsule can be discarded in the stool, and the monitor box (wireless receiver) must be returned to the clinic after completion of the test.

Risks: Uncommonly, patients will experience chest pain or discomfort due to the presence of the Bravo capsule in the esophagus. Rarely, the capsule will not fall off spontaneously, or food may hang up on the Bravo capsule, and endoscopy may be required to remove the capsule. The manufacturer advises that an MRI not be obtained if the Bravo capsule could still be in the body. If it has been longer than a month, it is ok to proceed with an MRI. If you need an MRI before one month, it is recommended you have an X-ray to evaluate if the Bravo capsule remains. The Bravo capsule will sometimes dislodge prematurely or not function properly and need to be reinserted.  

Alternatives: 24-hour Esophageal Impedance or Esophageal Manometry is an alternative catheter-based system that provides greater accuracy in general.


  • The most accurate results of this test are obtained if you have been off of your reflux medication (such as Prilosec, Prevacid or Dexilant) for seven days.
  • You may take Pepcid, Zantac or Tagamet up until two days before the test.
  • You may take Tums, Mylanta or Gaviscon up until six hours before the procedure.
  • You will receive in-clinic teaching regarding the wireless monitor and BRAVO test instructions prior to the procedure

Afterwards: If you have been sedated, you will need someone to drive you home. You must return the wireless monitor to SGS clinic upon completion of the test.  You may resume all prior antacid medications after completion of the test.