Diagnosis of reflux disease

There are numerous tests for which a diagnostic value in the context of gas tro-oesophageal reflux disease has been claimed. Some of these tests (e.g. the acid perfusion test) have become obsolete after the advent of 24-hour o esophageal pH monitoring. With the latter rest not only can excessive reflu x be identified, but also, and more importantly, a temporal relationship ca n be demonstrated between a patient's symptoms and reflux episodes. Radiogr aphical examination of the oesophagus has largely been replaced by endoscop y, although the use of the former test is still indicated in certain circum stances (e.g. in the differentiation of sliding from paraoesophageal hiatus hernia). In clinical practice, the so-called proton pump inhibitor test ha s gained considerable popularity. Despite several studies on the specificit y and sensitivity of this test, its value has not yet been established with sufficient accuracy. Conventional manometric evaluation of lower oesophage al sphincter pressure has been over-emphasized as a diagnostic test in gast ro-oesophageal reflux disease.