I am a GERD sufferer. I was diagnosed about six months ago by upper GI. What I want to know is: Can you be put to sleep while undergoing endoscopy?

C.J.

Gastroesophageal reflux disease (GERD) is a common ailment characterized by acid reflux into the esophagus from the stomach. It is caused by a lower-than-normal pressure in the sphincter that separates the stomach from the esophagus. Typical symptoms include heartburn, regurgitation and chest pain. The treatment for GERD involves suppressing stomach acid production with medications such as omeprazole (Prilosec) or lansoprazole (Prevacid). These medications are very effective at treating the symptoms of GERD in the vast majority of patients.

The diagnosis of GERD is often made based on a patient's symptoms. However, in some cases, more extensive diagnostic tests may be done to rule out other diseases, such as ulcers. In other cases, symptoms may indicate a complication of GERD, such as an esophageal stricture (narrowing of the esophagus due to scar tissue), and testing is necessary to investigate this. Finally, some patients fail to respond to appropriate medications, and a diagnostic test is done for further evaluation.

Most often, the diagnostic test of choice is an upper endoscopy. In this procedure, the doctor passes a flexible scope through the patient's mouth and into the esophagus and stomach. In addition to enabling the doctor to view those organs, endoscopy also can be used to take pictures and obtain tissue samples.

To answer your question, it is not advisable for a person to be "put to sleep" -- that is, receive general anesthesia -- before undergoing endoscopy. However, the procedure should be done in such a way that causes minimal discomfort to patients. Before the endoscopy, you should be given a sedative (typically, midazolam) and a painkiller (typically, meperidine). Although the you may not be completely asleep during the procedure, you should be comfortable and certainly should not feel any pain. In addition, a xylocaine spray is often applied to the mouth to reduce the sensation of the scope.

One advantage of using a sedative such as midazolam is that it often causes amnesia for events that follow its administration. Thus, you may not remember the procedure, even though you were somewhat awake while the endoscopic exam was being performed. If your doctor is considering an endoscopy to evaluate your GERD symptoms, you should discuss the details of the procedure with him or her so that you can become comfortable and less anxious about this procedure.