What’s Eating You? Part 2: Diagnosis and Treatment
Einstein Expert Explains Gastroesophageal Reflux Disease (GERD)
With Dr. Philip Katz, Chairman, Gastroenterology Department, Einstein Medical Center Philadelphia
Heartburn medications not working? Have a chronic cough or sore throat? You could be suffering from gastroesophageal reflux disease (GERD). According to the National Institute of Diabetes and Digestive and Kidney Diseases, 20 percent of Americans suffer from GERD. Einstein Medical Center specializes in diagnosing and treating GERD. Its state-of-the-art facility is helmed by GERD expert Dr. Philip Katz, chairman of Einstein’s gastroenterology department.
What is the procedure for diagnosing GERD?
Patient history is the primary diagnostic tool, Katz explains. “If the symptoms are well documented, a presumptive diagnosis can be made without further investigation,” he says. “However, chest pain and trouble swallowing should have diagnostic testing. Laryngeal and lung symptoms fall in the middle range. Many physicians would recommend diagnosis and testing but it is not always necessary.”
Monitoring patients’ response to medication is another diagnostic tool. “Most physicians test via therapeutic trial with medications like proton pump inhibitors,” Katz says. “If those don’t work, then something else is wrong, or the GERD is more serious than first thought.”
What kind of testing reveals damage to the esophagus?
“An endoscopy investigates the esophagus and upper GI tract,” Katz says. “In that testing, we look for specific changes to the lining of the esophagus, hiatal hernias, ulcers and erosions in esophagus.”
What other kinds of testing might be needed?
If GERD experts cannot confirm a diagnosis through medication responses or an endoscopy, two other testing modalities are available. Ambulatory reflux monitoring is done via a small telemetry capsule that is clipped to the esophagus for a monitoring period of two to four days. The attachment is made during the initial endoscopy. That capsule detects acid in the esophagus and communicates the information to a monitoring device that patients wear on their waistbands. About the size of cell phone, the device records the data, which is then downloaded to computer. Under some circumstances monitoring will be performed by placing a small tube in the nose for 24 hours to look for non-acidotic reflux as a cause for symptoms.
How is GERD treated?
“Treatment primarily revolves around medicine and lifestyle changes,” Katz explains. “Ideally, patients will modify their food intake by eating more slowly and having smaller meals. We also suggest that they don’t eat within two or three hours of going to sleep. When they do sleep, some people elevate their head in bed by approximately six inches. Others sleep on a wedge. Unfortunately, that helps only a small number of people. Almost everyone is going to need medication.”
Antacids, H2 receptor antagonists and proton pump inhibitors are used to treat GERD by neutralizing stomach acid and thereby decreasing symptoms.
What surgical options are used to treat GERD?
Patients who are intolerant of medication and those who do not wish to take medication long term or have continued symptoms despite medication can be considered for surgical procedures. The traditional surgical option is a fundoplication, Katz explains. Done through a laparoscope, fundoplication wraps the upper portion of the stomach around the esophagus to create a pressurized environment that reduces sphincter openings. The recovery time includes one night in the hospital, then seven to 10 days of recuperation before the patient fully returns to normal activity.
At Einstein, Katz is part of a team that performs a new procedure that just received FDA approval. Via an endoscope, a ringed magnetic device is placed around the esophagus just below the diaphragm. The goal, Katz explains, is to augment sphincter function. Patients can be back to normal the next day. “It is a much simpler procedure that is easier on patients, but it is not recommended for everyone,” Katz cautions. “Anyone with GERD symptoms should see a specialist who can determine the right course of action for each patient.”