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Advanced Testing and Treatment Options of Common GI disorders

Prabhakar P Swaroop M.D Gastroenterology

Common Reasons

• Heartburn • Difficulty swallowing • Regurgitation • Food gets stuck • Constipation

Two patients

• 55 year old male • Smoker • Goes to nearest fast

food/gas station for daily lunch

• Drinks more than a few beers in the evenings

• Snores • Carries TUMS in his

truck

• 55 year old woman • Long standing

constipation • Has used almost all OTC

meds with little or no success

• Occasionally has diarrhea but can go up to 2 weeks without BM

What tests can we do?

• Structural Tests – EGD – Colonoscopy – ERCP ( some MRCP) – CT/Ultrasound

• Functional Tests

GERD

• Gastroesophageal reflux disease or GERD is a chronic form of heartburn, which according to a Harvard Medical School Report, affects 10% of Americans on a daily basis.

• Acid related diseases are climbing in severity and they are a growing cause of sleep problems and work absences. This indicates an increasing need for early intervention, prevention and therapeutic services for this and other digestive concerns.

• Chronic heartburn, being the leading cause of Barrett’s esophagus, is a digestive concern that requires understanding and about which the public should be made more aware, as it is the beginning of a potential progression toward esophageal cancer

• Barrett’s esophagus (BE) or intestinal metaplasia (IM) is a change in the epithelial lining of the esophagus. BE develops as a result of chronic exposure of the esophagus to refluxed stomach acid, enzymes and bile.

• It occurs when a patient’s lower esophageal sphincter or valve no longer closes properly to prevent acid backwash into the lower esophagus. This results in recurrent mucosal injury. Such injury is accompanied by inflammation, and ultimately a cellular change (metaplasia) to a specialized columnar epithelium.19

• In a study published in 2005, BE’s prevalence was estimated to affect 3.3 million adults over 50 years of age in the United States.

• The prevalence of BE in the adult population is 0.4% to 1.3%, although recent reports from gastroenterology-selected populations suggest a higher prevalence.

• From 1975 to 2001, the frequency of esophageal adenocarcinoma rose approximately six fold in the U.S. from four to 23 cases per million people. At the same time, the rate of deaths due to this form of esophageal cancer has grown seven fold, from two to 15 deaths per million people.

• Patients with Barrett’s esophagus have an increased risk of developing esophageal adenocarcinoma at a rate that is 30 to 125 times higher than patients without this condition.7

• The American Cancer Society estimates that during 2010, approximately 16,640 new esophageal cancer cases were diagnosed.

• Even with aggressive therapy, the five-year survival rate from adenocarcinoma is only around 17%.

• Approximately 13% of Caucasian men over age 50 who have chronic reflux will develop Barrett’s esophagus.4

• In a study conducted by the Veteran Affairs Health Care System and Stanford University, 25% of patients over 50 years old without acid reflux symptoms were found to have Barrett’s esophagus.14

• GERD is common in the U.S. adult population. Symptoms of acid reflux, including heartburn, occur: – Weekly in 18% of U.S. adults16 – Monthly in almost 44% of U.S. adults16

Test Drive

24 hour pH/Impedance study

24 hour chart

Barrett’s esophagus

Narrow Band Imaging

• 3D WATS • HALO • Balloon Dilation

HALO RFA ( Radiofrequency Ablation)

HALO System

Balloon Dilation

Dilation

High Resolution Esophageal Manometry

Figure 3



Figure 4



Achlasia

Constipation

• Lack of Fiber • Medication • Lack of exercise • Hormonal • Mechanical • Neuromuscular • Pelvic floor dysfunction

Anorectal Manometry

Dyssenergic Defecation

• pregnancy • traumatic injury • low back pain • history of sexual

abuse/trauma • poor behavioral habits

related to bowel health • nothing (like many other

things, we sometimes just don’t know why it happens)

• Excessive straining to have a bowel movement

• Feeling of incomplete evacuation after a bowel movement

• Abdominal bloating • Frequent hard stools • Frequently utilizing digital

maneuvers to empty stool (this means, using a finger to either help pull stool out of the rectum, or using a finger to press inside the vagina to help empty)

Biofeedback Therapy

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