Will I need tests?
A doctor may diagnose reflux just by listening carefully when you describe your symptoms and may treat you without the need for any tests. If they are not sure however or if the treatment does not work well, it is probable that they will arrange investigations.
What tests can I expect?
The first investigation that doctors usually perform if they suspect you might have reflux oesophagitis is endoscopy. This involves passing a thin, flexible tube through the mouth and down into your oesophagus. The doctor will be able to get a really good look at your oesophagus and stomach and check whether there are signs of inflammation. Although it sounds unpleasant, your doctor will take care to explain how the discomfort of the procedure will be minimised. Although not used routinely, some specialists will choose to measure the amount of acid you are refluxing. This can be done by measuring the amount of acid in your oesophagus over a 24-hour period using a very narrow tube passed through the nose.
And if I do not fancy having an endoscopy?
No one is going to make you have tests although it is reasonable for the doctor to explain why it is important that you should do so. An alternative to an endoscopy is the barium meal test which will show up your oesophagus and stomach on x-ray. It does give less information than endoscopy but is good at showing up whether you have a hiatus hernia or whether your oesophagus is narrowed for any reason. It is worthwhile knowing that up to half of all patients with symptoms that suggest they have reflux turn out to have only mild inflammation or an oesophagus that looks quite normal.
Does it matter if I have a hiatus hernia?
The short answer is… not much. Instead of staying entirely in the belly as it should do, it is possible for part of the stomach to slide upwards into the chest. It does this by pushing itself through a hole (called the hiatus) in the diaphragm muscle. The hernia itself rarely causes any symptoms but it does seem to make reflux more likely. Do note (1) that hiatus hernia is very common, (2) that you can certainly have reflux without one, (3) that many people who have one do not get reflux. The importance of having a hiatus hernia can certainly be overrated.