Esophageal and Swallowing Disorders

Ohio GI offers comprehensive state-of-the art testing, evaluation, and recommendations regarding esophageal disorders. The main categories of esophageal problems are gastroesophageal reflux disease (GERD) including Barrett’s esophagus, disorders of esophageal contraction (motility disorders), swallowing disorders related to esophageal diseases, and swallowing disorders related to a dysfunctional swallowing mechanism (oropharyngeal dysphagia).

Gastroesophageal Reflux Disease and Barrett’s Esophagus
Gastroesophageal reflux occurs when abnormal amounts of gastric contents come up (reflux) into the esophagus. This is usually perceived as heartburn, chest discomfort, or a sense of regurgitation. Some patients have atypical symptoms leading to problems outside of the esophagus, per se. These might manifest as chronic cough, chronic sore throat or throat clearing or hoarse voice. Reflux has also been associated with poor sleeping pattern. After delving into the patients symptoms and performing a pertinent physical exam, testing may be recommended. Endoscopy (EGD) allows direct visualization of the esophagus and upper GI tract to inspect for reflux and related inflammation, assess for the presence of Barrett’s (see below) and other complications of chronic reflux, examine the anatomy for significant hiatal hernia or other abnormalities, and to see if the stomach is functioning properly. Esophageal acid analysis by measuring pH in the esophagus over 1-2 days can objectively quantify reflux. This can be done as part of an endoscopy by attaching a small battery powered wireless pH sensor in the esophagus that measures acid reflux for 48 hours then later spontaneously falls off and is harmlessly passed. Esophageal pH can also be measured with a nasal catheter ambulatory 24 hour pH probe combined with impedance testing. Esophageal impedance is a newer technology that we introduced into the community via leadership as the Director of the Swallowing Center at The Christ Hospital. This allows the addition of assessing esophageal symptoms that may be related to reflux of nonacidic gastric contents. After evaluations, an individualized treatment plan is then recommended including dietary and life style advice, medication, and occasionally surgery.

Barrett’s esophagus is a condition when the normal esophageal lining cells change into intestinal type cells as a response to chronic acid reflux. Barrett’s esophagus is a potentially precancerous condition and when diagnosed, is followed by intermittent endoscopy with directed biopsies. We can utilize a technology called Narrow Band Imaging that highlights the appearance of Barrett’s during endoscopy for focusing biopsies obtained. There is a gradation of changes that can occur that can progress to cancer. These changes are called dysplasia and when it occurs, we offer nonsurgical treatments, when appropriate including Radiofrequency Ablation and Endoscopic Mucosal Resection to remove the Barrett’s and dysplasia to prevent cancer development.

Disorders of Esophageal Contraction (Motility Disorders)
Esophageal motility disorders cause abnormalities in the contraction mechanism of the esophagus usually manifesting as non-cardiac chest pain or the sensation that food and/or liquids seem to get hung up in the chest after swallowing. The primary motility disorders are achalasia, diffuse esophageal spasm, nutcracker esophagus, and ineffective peristalsis. Esophageal function is usually assessed with motility testing, also called manometry. We now offer High Resolution Manometry that more accurately evaluates the motor function of the esophagus. Patients with esophageal motility disorders are then treated, for example in achalasia, they may undergo pneumatic endoscopic balloon dilation, BoTox injection, or be referred to a surgeon, as appropriate for each individual circumstance based on detailed consultation.

Esophageal Disorders
There are many disorders that are solely esophageal disorders and others that occur in the esophagus as a consequence of having other diseases. These are diagnosed and treated via expert consultation and appropriate testing. Of the long list of disorders we specialize in, a few of the more common ones include: Schatzki ring and other esophageal strictures that we dilate (stretch) for relief and eosinophilic esophagitis.

Dysfunctional Swallowing Mechanism (Oropharyngeal Dysphagia)
In addition to swallowing disorders caused by esophageal strictures/narrowing or disorders of esophageal motility, oropharyngeal dysphagia occurs when the swallowing mechanism is disordered, impairing the ability to swallow. This usually is a consequence of neurological disorders (stroke, Parkinson’s, Alzheimer’s and others). We offer consultation, evaluation, and treatments in coordination with speech therapist. Placement of a percutaneous endoscopic gastrostomy (PEG) can provide full nutrition and hydration in those who can not safely or adequately eat and drink.