What’s Eating You? Part 1: Symptoms


    Dr. Philip Katz, chairman of the Gastroenterology Department at Einstein Medical Center Philadelphia, explains gastroesophageal reflux disease, or GERD.

    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 GERD?

    “GERD is caused by gastric contents, including acid, that return – or reflux – into the esophagus,” Katz explains. “When we swallow, the lower esophagus opens and allows food and liquid to pass. Then it closes. Reflux – the medical term for which is transient relaxation – happens when the muscles open when they shouldn’t. The sphincter does not function correctly. If there is significant reflux, acid can damage the lining of the esophagus. Over time, there is the possibility that the esophagus will not clear the acid.

    “The problem is exacerbated when we sleep,” Katz continues, “because during sleep, we don’t swallow as frequently or make as much saliva as when we are awake. These are functions which help clear and neutralize acid.”

    What are the symptoms of GERD?

    The most common symptom is heartburn, Katz says. This is different from chest pain, which is another GERD symptom. But GERD-related heartburn is distinct. “The classical presentation is burning under breastbone that rises to neck,” he explains. “This can happen after a meal, when lying down or when asleep. The second most common symptom is regurgitation, the spontaneous return of stomach contents into the throat. It will feel like something is coming up the throat very quickly. It almost exclusively occurs after eating or when lying down – and without nausea. That distinguishes it from other vomiting.”

    Vocal problems – laryngitis, a chronic sore throat, constant throat clearing and loss of voice towards the end of the day – can be symptoms of GERD. They are believed to be the result of stomach acid refluxing from the esophagus and hitting the vocal chords.

    Chronic coughing is another potential symptom of GERD; asthma may be another. “People get symptoms that are referred to as respiratory problems, but they can be from acid getting into the lungs,” Katz says.

    In some cases, people with GERD can have trouble swallowing. That is a result of damage to the esophagus, or narrowing of it. Stomach acid is again to blame, Katz explains, because it causes a repetitive injury to the esophagus and that creates scar tissue.

    When is time to see  a doctor?

    In many cases, the symptoms are chronic but static and not life-endangering, Katz says. In other cases, the symptoms progress and get worse. What motivates most people to finally seek help is that their quality of life has deteriorated, Katz says. But they need not wait that long. Einstein has a state-of-the-art esophageal testing laboratory headed by Katz, who is conducting research into GERD. “We recommend that people who have heartburn more than two or three times per week should seek help,” he says. “Anyone who has chronic heartburn that is not relieved by over-the-counter medication should see a physician.”

    Next: Diagnosing and Treating GERD