Acid Perfusion (Bernstein) Test

Norm of Acid Perfusion (Bernstein) Test

No burning or pain after saline or acidic infusions.


Usage of Acid Perfusion (Bernstein) Test

Differentiation between chest pain caused by a cardiac disorder and chest pain caused by esophagitis. Not commonly used by cardiologists; more often used by gastroenterologists. Aids diagnosis of gastroesophageal reflux as a cause of nocturnal asthma or hiatal hernia and in Barrett's esophagus. This test is obsolete if 24-hour esophageal pH monitoring is available.


Description of Acid Perfusion (Bernstein) Test

Saline and then acidic solutions are slowly perfused through a nasogastric tube into the stomach. Clients with esophagitis caused by relaxation of the lower esophageal sphincter usually experience burning or pain after the perfusion of acidic solution but not after the saline solution. Gastroesophageal reflux has been found to occur in some clients with nocturnal asthma. Such clients show an exacerbation of asthmatic symptoms when this test is performed.


Professional Considerations of Acid Perfusion (Bernstein) Test

Consent form NOT required.

Exacerbation of asthma in asthmatics. Complications of nasogastric tube insertion include bleeding, dysrhythmias, esophageal perforation, laryngospasm, and decreased mean pO2.
Cardiac disorders; esophageal varices.



  1. Obtain nasogastric tube, tape, gel, glass of water, and a liter each of normal saline solution and 0.1 N hydrochloric acid (HCl) solution.
  2. See Client and Family Teaching.



  1. Mark a nasogastric tube at 12 inches from the distal tip.
  2. Insert the nasogastric tube into the stomach and aspirate stomach contents.
  3. Withdraw the nasogastric tube until the 12-inch mark is at the tip of the nares. This ensures that the tube tip is located in the esophagus and not in the stomach (in the adult client).
  4. Perfuse normal saline into the nasogastric tube at 60–120 drops per minute. Assess for discomfort after 10 minutes.
  5. Connect 0.1 N HCl solution piggybacked onto the normal saline line. Close the clamp on the normal saline and open the line on the HCl solution at a rate of 60–120 drops per minute for 30 minutes or until the client spontaneously complains of discomfort or when assessed every 10 minutes.
  6. At the first sign of discomfort, clamp the HCl and open the normal saline line until the client experiences no further pain or burning.
  7. Clamp and remove the nasogastric tube.


Postprocedure Care

  1. An antacid may be necessary if discomfort continues after the test.


Client and Family Teaching

  1. Fast and do not smoke for 12 hours before the test.
  2. Antacids should not be ingested within 24 hours before the test.
  3. The test involves insertion of a tube through the nose into the stomach. The insertion may be uncomfortable and cause a pressure-like feeling or cause you to gag and cough. You will be asked to take sips of water and swallow to make tube insertion easier.
  4. The test may reproduce the pain in 20% of clients, but this will help differentiate the cause of the pain, and the discomfort will be temporary.


Factors That Affect Results

  1. None found.


Other Data

  1. This procedure has been used in some studies to monitor the effect of gastroesophageal reflux on air exchange.
  2. See also Esophageal acidity test and Esophageal manometry.