Most children with reflux do not need any tests. The disease is most often diagnosed by taking a careful history and asking the parents lots of questions.

If your doctor recommends a test, this information may help. You can also chat with other parents on the discussion boards before the test

pH probe

What is a pH probe?

A pH probe is a thin, flexible tube, where one end of the tube is attached to a probe that measures acidity and the other end is connected to small recording device that can usually be worn around the waist or over the shoulder.

What should I expect during this study?

During an esophageal pH monitoring study, the nurse will pass this tube through the nose, down the back of the throat, and into the esophagus (your child will be asked to swallow in order to aid the process). The tube is then taped in place. Oftentimes the doctor will take an x-ray to determine the exact positioning of the tube. The probe is left in the esophagus for 18 to 24 hours in order to obtain both daytime and nighttime acid reflux activity. You will be asked to keep a timed diary of the child’s activity (including physical activity, crying, coughing, etc.) and food/liquid intake. Removal of the tube takes less than a minute and is painless. You should be able to stay with your child during both the placement and the removal of the tube.

Will my child be given a sedative?

Your child may gag, sneeze, or cough when the tube is being passed through the nose and into the esophagus. “Swallowing” the tube may be uncomfortable, but once the tube is in place, it should not hurt. Your child will not, nor will he or she need to be, sedated.

Does my child have to stay in the hospital?

Admittance is to the doctor’s discretion; oftentimes, younger children will be admitted for the duration of the test, while older children are often allowed to go home and participate in normal, daily activities (including eating!), and return for removal of the tube.

What should I ask the doctor?

You should be sure to ask the doctor exactly time parameters for fasting before the procedure, which foods especially to avoid, whether you can remove the recorder during a bath or shower, whether you should still administer your child’s medicine the day or two days before, and, if your child has asthma, whether that will interfere with the procedure.

What is a pH probe used to determine?

Because a pH probe can measure and record reflux episodes and the lengths of reflux episodes, the results can determine whether a child has GER or GERD when compared to the normal number and lengths of reflux episodes. A pH probe can also determine whether the medicine is controlling the acid in your child’s stomach by measuring the effectiveness of the esophagus in clearing acid.

What do I do to prepare for a pH probe study?

Your child should not eat any solid food after midnight the night before the test, and should have no liquids except water four hours prior to the test (breast milk is usually allowed up to two hours before the test). Do not administer any antacids or acid-reducing medications (including Prilosec, Tagamet, Zantac, Axid, Prevacid, Pepcid, Maalox, Tums, and Gelusil). During the actual study, do not give your child foods or liquids that are high in acid (including juice, soda, popsicles, sherbet, fruit, fruit-flavored hard candy, ketchup, and tomato products). (Please be aware that food/liquid intake guidelines may vary from hospital to hospital; verify exact procedures with your doctor.) You should also try to explain what will happen during the test to your child in simple, reassuring language.

When will I get results back?

Results are usually returned within a week.

How does a pH probe study differ from other tests to determine GER or GERD?

A pH probe study records reflux episodes over a longer period of time, giving a better sense of daily acid activity in a child’s esophagus and stomach. If your child has mild acid reflux, the larger symptoms determined using an upper endoscopy such as Barrett’s esophagus or reflux esophagitis may not be present, in which case a pH probe study can be a better indication of abnormal reflux.

This information was pulled from the University of Michigan Section of Pediatric Surgery (http://pediatric.um-surgery.org/new_070198/new/Library/24%20HOUR%20pH%20PROBE%20TEST.htm), Children’s Hospital Boston (http://www.childrenshospital.org/clinicalservices/Site2002/mainpageS2002P24sublevel29.html), and Barretsinfo.com (http://www.barrettsinfo.com/content/info_2b3_ph_monitoring.htm).


Upper Endoscopy

What is an upper endoscopy?

An upper endoscopy, also called an esophagogastroduodenoscopy, is a procedure in which the doctor inserts an endoscope (a long, flexible, tube with its own camera and light source) through the mouth (or, more rarely, through the nose), down the esophagus, through the stomach, and into the duodenum (the first part of the small intestine). It is also one of the most frequently performed endoscopic procedure.

What should we expect during an upper endoscopy?

The entire procedure should take 10-30 minutes, depending on whether the doctor wants to give treatments or take biopsies. The patient will experience pressure on his or her throat and a “full” feeling in the stomach. A doctor may insert instruments into the endoscope to treat bleeding abnormalities and can also remove samples of tissue for further examination. The doctor may also want to monitor the child’s heart rate, oxygen level, and blood pressure during the procedure, depending on the sedative used.

Will my child be given a sedative?

Yes. The patient will receive a conscious sedative (this could be a numbing spray administered to the throat, an IV, or another form of sedative) before the procedure to reduce gagging and discomfort. You should expect your child to stay at the facility at least 1-2 hours after the procedure so the medication can wear off.

What should I ask the doctor before the procedure?

You should determine whether the doctor will be taking any biopsy samples from your child’s digestive tract, and if so, the associated risks.
What is an upper endoscopy used to determine?

Using the endoscope, the doctor can view the lining of the esophagus, the stomach, and the duodenum directly. The endoscope can also blow air into the stomach so that the folds of tissue expand, providing a better view of the stomach lining. This up-close look can determine the reason for swallowing difficulties, nausea, reflux, vomiting, bleeding, and abdominal/chest pain. Red lining in the esophagus may indicate Barrett’s esophagus (though oftentimes stomach lining is found at the base of the esophagus, and so the doctor may opt to take a tissue sample in this case). The detailed view also allows the doctor to detect small abnormalities that may be missed in barium esophagrams and x-rays. Reflux esophagitis (an inflamed esophagus due to acid), peptic strictures (the narrowing of the esophagus due to reflux), or Barrett’s esophagus (a change in lower esophageal cells) are diagnostic of GERD and can be found very easily using an upper endoscopy.

What should I do to prepare for an upper endoscopy?

The stomach needs to be empty during the procedure, and so the patient may not eat or drink anything six hours prior to the exam. If your child is of driving age, he or she should not be allowed to drive home due to the medications given at the time of the procedure. Try to avoid aspirin for a few days before the test. You may want to bring along juice or formula to give your child after the tube has been removed. You should also try to explain what will happen during the test to your child in simple, reassuring language.

How does this test differ from other tests used to determine GER/GERD?

An upper endoscopy provides a direct, detailed view of the main areas affected by GER/GERD, and can detect inflammation, tumors, and ulcers more accurately than other tests that make use of x-rays. The doctor can also administer treatment during the procedure and take biopsies.

What are possible complications associated with an upper endoscopy?

Possible complications include bleeding and puncturing the stomach lining (1 in 1000 chance). There is a chance that the patient will contract pneumonia if fluid enters the lung. The most common complaint is just a mild sore throat or neck pain after the procedure.

When will I get results back?

Usually, results from an upper endoscopy should be available before the patient is discharged, the day of the procedure. However, biopsy results may take three to four days, and the doctor may then only give you a preliminary diagnosis.


This information was pulled from the National Disgestive Information Clearinghouse of the National Institute of Diabetes and Digestive and Kindey Disease of the National Institute of Health (http://digestive.niddk.nih.gov/ddiseases/pubs/upperendoscopy/index.htm), Barrettsinfo.com (http://www.barrettsinfo.com/content/3a_what_is_egd_with_biopsy.htm), and the American Society for Gastrointestinal Endoscopy (http://www.askasge.org/pages/procedures/upper/understanding.cfm).

Please access the Barrettsinfo.com site for pictures of the procedure and what you can expect to see on the screen during the upper endoscopy.

Barium Swallow

What is a barium swallow?

A barium swallow refers to the x-ray examination of the pharynx and esophagus after the patient has swallowed a barium solution that coats the lining of the upper digestive tract, since this part of the body does not usually show up on x-rays. This procedure is usually called an upper GI (gastrointestinal) when the doctor examines the stomach and the duodenum (the upper part of the intestine) as well as the esophagus.

What should I expect during a barium swallow or upper GI?

The patient may be asked to swallow baking soda crystals or other “fizzing” tablets that produce gas (try not to belch even if you feel the need to) in order to clarify the picture before the solution is swallowed. During the procedure, the patient will be asked to first stand, then lie, and possibly to roll on their side in order to thoroughly coat the digestive tract and to obtain different angles. The radiologist will first observe the motion of the barium using a fluoroscope (don’t worry, none of this equipment should come into direct contact with the patient), after which x-rays will be taken with an x-ray machine. The patient will usually be wearing a gown with no metal straps (these would appear on an x-ray), and if your child cannot lie still, he or she may have to wear a special seat belt. With preparation, the procedure may take up to two hours, especially since sometimes the radiologist waits for the barium to pass through some of the system. You should be able to stay with your child and leave right after the procedure is done, though sometimes the radiologist will ask you to wait outside.

Will my child be given a sedative?

No. This procedure is non-invasive and should not hurt at all.

What is a barium swallow/upper GI used to determine?

A doctor will usually order a barium swallow or an upper GI when the patient is experiencing chest or stomach pain, having trouble swallowing, or unexplained vomiting. The test can detect abnormalities such as ulcers, tumors, and inflammation in the esophagus, stomach, and duodenum since the doctor can observe the digestive tract of the patient.

What should I discuss with my doctor in the event of a barium swallow/upper GI?

Inform your doctor of the number of x-rays your child has taken in the past year, and of any allergies your child may have (since many barium solutions are flavored). Your doctor should also know of any gastrointestinal blockages.

What should I do to prepare for a barium swallow/upper GI?

The doctor will probably ask that the patient not eat or drink anything except water midnight before the day of the test, since the digestive tract and stomach must be empty for accurate x-rays. No antacids and no gum will also be requested. You may want to bring along juice or formula to give your child after the test. You should also try to explain what will happen during the test to your child in simple, reassuring language.

How does this test differ from other tests used to determine GER/GERD?

This test is non-invasive, unlike both the pH probe and the endoscopy. The doctor will be able to observe the digestive tract, which is very important when dealing with a patient who may have reflux, but the images may be blurry and are not as direct as images obtained with other methods.

What are possible complications associated with a barium swallow/upper GI?

Your child may be allergic to a flavoring used in the barium solution, so please inform your doctor of any strong reactions to citrus flavors or other commonly used flavorings. There is a chance that some barium will stay in the system, so if the gastrointestinal tract is blocked, the procedure may not be safe. There is a small amount of radiation involved, so if your child has been taking many x-rays lately, please bring that up with the doctor. The patient should drink more water to clear the system of barium after the procedure, and don’t be worried if the patient’s stool is gray or white for two or three days.

When will I get results back?

This depends on the center; it usually takes only half an hour to an hour to develop the x-ray film, but it may take the doctor longer to evaluate the images and determine a diagnosis. Results could come anywhere between two days and a week.

This information was obtained from the Harvard Family Health Guide (http://www.health.harvard.edu/fhg/diagnostics/upperGI/upperGI.shtml), radiologyinfo.com (http://www.radiologyinfo.org/en/info.cfm?pg=uppergi&bhcp=1), and the American Society of Radiologic Technologies (http://www.asrt.org/content/ThePublic/AboutRadiologicProcedures/Upper_GI_Series.aspx).


Videofluoroscopic Swallow Study

What is a videofluoroscopic swallow study?

A videofluoroscopic swallow study (VFSS or VSS), also known as a modified barium swallow study or an oral-pharyngeal motility study, is an exam in which the patient swallows various foods and liquids mixed with barium while a radiologist takes images of the mouth and throat using a moving x-ray (fluoroscope). The images are recorded and can be evaluated to assess how food is passing through the mouth into the throat and to examine the swallowing mechanism.

What should I expect during a VFSS?

In some cases, the doctor will ask you to bring foods and liquids that your child normally eats and drinks. The food and liquids will be mixed with barium, which is not harmful but may taste chalky. The child will be wearing lead shields and if you as a parent are administering the food (ask if this is possible, in order to replicate the feeding situation as closely as possible), you will be wearing a lead apron to protect against radiation. A speech pathologist will most likely dictate which types/textures of food to feed your child and how much. The radiologist will take a moving x-ray video of your child’s mouth and throat as he or she eats and swallows. The entire procedure should take 10-15 minutes.

Will my child be given a sedative?

No. This procedure is not painful at all, though the barium may taste chalky.

What is a VFSS used to determine?

A VFSS is performed usually when the patient is having trouble swallowing, chokes/coughs frequently, takes abnormally long (more than 30 minutes) to finish one bottle, cannot eat the recommended amount of food for his or her age, has poor weight gain, or forgets to breathe during feeding. The moving x-ray allows the doctor to evaluate the efficiency of your child’s swallowing mechanism. The pathologist should be able to tell you what textures of food and how much your child can safely eat. A VFSS can also show aspiration (which is when foreign matter like food enters the lungs) if barium appears in the windpipe.

What should I discuss with my doctor in the event of a VFSS?

Inform your doctor of the number of x-rays your child has taken in the past year, and of any allergies your child may have (since many barium solutions are flavored). Tell your doctor if your child has ever had negative reactions to barium in the past. You should also discuss your child’s normal diet and eating patterns.

What should I do to prepare for a VFSS?

Some hospitals will ask you to bring your own foods and liquids (typical foods for your child). You should try and bring a cup or bottle from which your child normally drinks. Make sure your child is not wearing metal snaps or straps or buckles near the neck, as any metal objects will appear on the x-ray.

How does this test differ from other tests used to determine GER/GERD?

This test is more concerned with your child’s ability to swallow different foods. This test is not diagnostic of GER or GERD, but rather will give you useful information on what types of food your child can be eating, and also whether your child’s swallowing mechanism is functioning properly. This test is also non-invasive.

What are possible complications associated with a VFSS?

There is a small amount of radiation involved, so if your child has been taking many x-rays lately, please bring that up with the doctor. The patient should drink more water to clear the system of barium after the procedure, and don’t be worried if the patient’s stool is gray or white for two or three days.

When will I get results back?

The pathologist should be able to discuss the types of textures your child should and should not eat right after the exam, but evaluation of the video images to assess the swallowing mechanism may take a couple days to a week.

This information was obtained from Vanderbilt Children’s Hospital (http://www.vanderbiltchildrens.com/interior.php?mid=1460), the Mayo Clinic (http://www.mayoclinic.org/swallowing-problems/vfss.html), and feeding.com (http://www.feeding.com/images/FAQ%20MBS.pdf).

Milk Scan

What is a milk scan?

A milk scan, also known as a gastroesophageal scintigraphy, is a procedure in which the child drinks milk, breast milk, or formula that has been mixed with a radiopharmaceutical (a slightly radioactive material). A gamma camera records the progress of the treated milk by focusing on the esophagus (recording the number of reflux episodes), the stomach (tracking the rate of gastric emptying), and lungs (to determine whether aspiration – the entrance of foreign material into the lung – is occurring).

What should I expect during a milk scan?

You may be asked to bring in 8 ounces of milk, breast milk, or formula (whichever your child is most comfortable drinking). The doctor will add a radioactive substance to the milk; this should not alter the taste in any way. Your child will be asked to drink 2-8 ounces of the treated milk in ten minutes. The scan will begin as your child is swallowing – usually the doctor will set up a camera underneath the table that your child is seated on. Your child will most likely to be asked to lie down so that the camera can record images of the gastrointestinal tract. The camera will take pictures every 5-30 seconds for 1-2 hours in order to track the substance through the digestive process. If your child has trouble swallowing, the liquid may be administered through a nasogastric tube that goes through the nose and into the stomach. You should be able to stay with your child for the duration of the test, and you may be able to bring along entertainment for your child.

Will my child be given a sedative?

No. The procedure is both non invasive and not painful.

What is a milk scan used to determine?

A milk scan can measure reflux into the esophagus quantitatively, detect aspiration, and measure gastric emptying. Milk scans are diagnostic of gastroesophageal reflux.

What should I discuss with my doctor in the event of a milk scan?

Your doctor should know of any reactions your child has had to milk and milk products. Talk to your doctor about whether you think your child will be able to lie still for an hour or two, and whether you can bring in a favorite video, DVD, or CD to play during the study.

What should I do to prepare for a milk scan?

The doctor will usually ask that your child not eat or drink anything for four hours before the test. Some doctors will require that you bring 8 ounces of milk, breast milk, or formula. You may want to bring a DVD, video, or CD to entertain your child during the exam. Dress your child in comfortable clothing.

How does this test differ from other tests used to determine GER/GERD?

This test is more sensitive than a pH probe in detecting reflux. It may also be a more accurate representation of the gastrointestinal tract’s function, since the process more closely resembles a normal feeding. The images are more versatile than a pH probe’s recording. However, the milk scan cannot detect structural abnormalities, unlike an endoscopy or a barium swallow study.

What are possible complications associated with a milk scan?

The radioactive substance should not harm your child at all, but you may want to discuss risks with your doctor before the procedure.

When will I get results back?

It may take up to a week for the doctor to evaluate the images and return a diagnosis.

This information was obtained the Children’s Hospital of Philadelphia (http://www.chop.edu/consumer/jsp/division/generic.jsp?id=84200), American Family Physician (http://www.findarticles.com/p/articles/mi_m3225/is_n3_v43/ai_10592415/pg_4), and Medscape (http://www.medscape.com/viewarticle/440529).