Acid perfusion test

Acid Perfusion Test, also known as the Bernstein test, is a diagnostic procedure used to identify the cause of esophageal pain, particularly when gastroesophageal reflux disease (GERD) is suspected. The test involves the perfusion of a mild acid solution and a saline (salt) solution into the esophagus. The aim is to reproduce the symptoms of heartburn to confirm if the esophageal pain is due to acid reflux.

Procedure

The Acid Perfusion Test is conducted in a controlled clinical setting. The patient is positioned in a manner that simulates the conditions under which they typically experience esophageal discomfort. A thin, flexible tube (catheter) is then passed through the nose, down the throat, and into the esophagus. The catheter is equipped with sensors that measure the pressure within the esophagus and its reaction to the acid solution.

Initially, a saline solution, which should not cause discomfort if the esophagus is healthy, is perfused through the catheter. Following this, a dilute hydrochloric acid solution, mimicking the stomach's acid, is introduced. If the patient experiences pain or discomfort similar to their symptoms during the acid infusion but not during the saline infusion, the test is considered positive, indicating that the esophageal pain is likely due to acid reflux.

Clinical Significance

The Acid Perfusion Test is particularly useful in cases where other diagnostic tests for GERD, such as endoscopy or 24-hour pH monitoring, have not provided conclusive results. It helps in distinguishing esophageal pain caused by acid reflux from other potential causes such as esophageal spasm, achalasia, or cardiac issues.

Limitations

While the Acid Perfusion Test can be useful, it has limitations. The test's specificity and sensitivity are not perfect, meaning it may not detect all cases of acid-induced esophageal pain, and it may yield false positives. Additionally, the test is somewhat invasive and can be uncomfortable for the patient, leading to its decreased popularity in favor of non-invasive tests that have become more available and advanced over time.

See Also

• Gastroesophageal reflux disease
• Esophageal manometry
• Barrett's esophagus