Abstract :Gastroesophageal Reflux Disease (GERD) is a common problem, with a prevalence ranging between
10% and 20% according to the geographic area, which is expensive to diagnose and treat in both
primary and tertiary care settings. Diagnosing GERD poses many problems: firstly, gastroesophageal
reflux may be a physiologic phenomenon, and hence a quantitative and not qualitative test is needed.
Secondly, symptoms are rather unspecific and it may be difficult to link them to GERD, particularly
in the setting of extraesophageal manifestations. Endoscopy is very useful when complications are
found, namely erosions, ulcers or Barrett’s metaplastic epithelium, yet the majority of patients with
GERD have a Negative Endoscopy (so called NERD) despite typical symptoms. Esophageal 24h
pH-monitoring and pH-impedance examinations have greatly increased the diagnostic yield, but
they are not universally available and are quite expensive. Finally a PPI test may be attractive in the
setting of general practitioner, but its sensitivity and specificity are rather poor. In conclusion, we
still face a disease which has only imperfect ways of truly being diagnosed.