Modern diagnosis of gastroesophageal reflux disease (GERD).

Typical dominant symptoms such as heartburn and regurgitation are very specific for the diagnosis of GERD. Unfortunately they are relatively insensitive. The diagnosis can be made reliably if mucosal breaks are present at endoscopy. In endoscopy-negative patients with atypical symtoms, the most accurate investigation is 24-hour pH-monitoring with symptom analysis. Another alternative which may prove more cost-effective is to start with a PPI-test (e.g. omeprazole 20 or 40 mg bid for one or two weeks) and to use the symptomatic response as a diagnostic test.