Diagnostics
(many patients will have GORD) but also confirm those who don’t have GORD. Misdiagnosis is common: symptoms like bloating, belching, and regurgitation may point to SIBO, not acid reflux, which can be easily detected with a simple at-home breath test. Others may have a hiatus hernia — around 10% of GORD patients — and need surgery, not PPIs.8
The current
pathway treats symptoms, not causes. Most GORD patients need lifestyle support. A minority need cancer surveillance. And another minority need a different referral pathway altogether; one that recognises microbiome disruption, motility disorders and structural disease. With NHS England’s push toward prevention and community-first care, it’s time to build smarter pathways for patients reporting reflux, to reflect the complexity behind the symptoms.
Diagnostics that make a difference Reflux symptoms are common — but the causes aren’t always clear. For patients with persistent heartburn, bloating, or regurgitation, early diagnostics can make all the difference: identifying high-risk patients, reducing unnecessary prescribing, and streamlining referrals. l Capsule Sponge - GORD patients can be offered Endosign capsule sponge testing — a non-endoscopic cell collection tool that detects Barrett’s oesophagus and pre-cancerous changes. Endosign offers community-based triage, faster access to surveillance and reduced strain on endoscopy units (as only patients with suspicious cell changes will need endoscopy). If it is a positive result, the doctor can escalate to cancer pathway; if it is negative then the benign pathway can begin.
l Manometry - Before pH testing, oesophageal manometry maps muscle coordination and sphincter function. It’s essential for localising the lower oesophageal sphincter before placing pH probes, identifying motility disorders like achalasia or rumination and
A healthcare professional fits a tube, which measures acid reflux over a 24-hour period to diagnose GORD.
assessing surgical suitability e.g. for LINX or RefluxStop, TIF, cTIF or reflux surgery. Performed via a nasal catheter, manometry is low-resource, sedation-free, and increasingly available in community settings.
l pH testing - While Bravo capsule testing offers a tubeless, 96-hour readout, it requires endoscopy for placement and only measures acid at a single point in the oesophagus. In contrast, catheter-based pH impedance testing uses a nasal tube with multiple electrodes and can be fitted in a community setting by one healthcare professional, such as a Clinical Scientist or Physiologist. It captures acid and non-acid reflux, gas reflux episodes, height of reflux (even up to the throat) and correlation with symptoms (patients press a button during episodes). It’s like a physiological barium swallow — revealing not just if reflux occurs, but how, when, and how far. Though some patients find the tube uncomfortable, and it only runs for 24 hours, it offers a richer diagnostic picture.
Early diagnostics don’t just clarify symptoms — they stratify cancer risk. The DELTA study shows that algorithm-led triage using capsule sponge and prescribing data can flag high-risk patients earlier, reduce unnecessary PPI use, and deliver economic benefit to the NHS. With GORD linked to oesophageal adenocarcinoma, the case for smarter, earlier testing is clear.9
A healthcare professional guides in the capsule sponge device. This is used to collect cells from the oesophagus and is sent to the lab to be assessed for cancerous changes.
Prevention not cure In reflux care, the first step shouldn’t be a prescription, it should be a conversation. Lifestyle, diet, smoking or alcohol cessation and over-the-counter strategies remain the most underused tools in our clinical arsenal, despite growing evidence that they can reduce symptoms, improve quality of life, and protect the gut microbiome. Clinical trials underway here at the Functional
Gut Clinic are now validating what many of us have seen in practice: that targeted dietary interventions, behavioural change, and microbiome support can reduce the need for acid suppression therapy and help patients avoid escalation to secondary care. NICE guidance already recommends step-down therapy and lifestyle-first management for non- erosive reflux, but implementation is patchy, and clinical inertia persists. We need to equip primary care clinicians
with proven, physiology-led tools that work. That means offering structured lifestyle plans, microbiome-safe OTC options and clear referral pathways for functional testing when symptoms persist. This isn’t just about symptom control; it’s about restoring gut function, preserving microbial diversity, and giving patients back a sense of agency. Reflux affects over millions of people in the
UK. For many, the answer isn’t more medication - it’s better information. When we prioritise prevention, we reduce prescribing burden, improve patient outcomes and build a healthier, more resilient gut from the inside out, which is critical for overall wellness.
NHS cost logic Gastro-oesophageal reflux disease (GORD) costs the NHS an estimated £760 million annually. This estimate includes not only the direct treatment costs of drugs like PPIs and diagnostics like endoscopy, but the wider economic impact of absenteeism.10
Yet much of this burden is from
inefficiency. Better diagnostics embedded could dramatically reduce long-term costs by: l Reducing unnecessary PPI prescribing: Over 73 million PPI prescriptions were issued by NHS England last year, at a cost of over £190million in England alone 1
l Enabling earlier cancer detection: Tools like capsule sponge can identify Barrett’s
December 2025 I
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