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Digestive Conditions of the Esophagus and Stomach

The Center for Digestive Health at Beth Israel provides a detailed and focused approach to esophageal and stomach disease. We offer internationally recognized expertise in the surgical, gastroenterological and endoscopic management of these disorders, and work closely with our highly skilled radiologic and oncologic colleagues when necessary in order to provide the most appropriate therapeutic program with a patient-centered approach.

Conditions we treat:

Diagnostic Tools
Treatment Options


Cancer
If a cancer of the esophagus or stomach has already been diagnosed, the Center’s gastroenterologists, surgeons and oncologists have regionally and nationally recognized expertise in treating these.


GERD

Heartburn and Gastroesophageal Reflux Disease (GERD)
Heartburn is extremely common with 10% of the population and 25% of pregnant women experiencing symptoms daily. Even though heartburn is common, it is rarely life threatening and often can be managed with medications and lifestyle changes. Severe cases, however, can result in or threaten injury to the lower esophagus, irritation to the lungs and throat, and other complications that may require endoscopic or surgical treatment. Watch this Webcast to learn more about how to manage heartburn.


Swallowing Difficulties (Dysphagia)
Patients may experience difficulty swallowing, a condition which can arise from a variety of reasons, including:

  • Damage from GERD (esophagitis, esophageal ulcer and esophageal stricture)
  • Esophageal cancer
  • Achalasia - a disorder that involves loss of motility of the esophagus and failure of the lower esophageal sphincter to relax
  • Scleroderma - an autoimmune disease affecting the esophagus
  • Diffuse esophageal spasm - a disorder with abnormally powerful contractions of the muscles of the esophagus
  • Eosinophilic esophagitis - an allergic response that occurs in the esophagus with an infiltration of eosinophils (special inflammatory cells)

All of these conditions require prompt diagnosis and treatment.


Barrett's Esophagus
Barrett's esophagus can occur when long standing reflux severely irritates the lining of the esophagus so that cells undergo a change in appearance to more like those of the intestine. This transformation is called intestinal metaplasia. In this condition there is a small, but definite, risk of a subsequent cancer. Once Barrett's esophagus has been recognized (it does not produce its own symptoms), it requires periodic monitoring by endoscopy to detect early pre-cancerous changes known as dysplasia. The Center is one of the few places in the world, and the only one in New York, to use a system that allows visualization of abnormal cells during endoscopy which helps detect these pre-cancerous changes. Watch this Webcast to learn more about Barrett’s esophagus and how it is treated.


Gastritis
A common condition caused by inflammation of the stomach’s lining that can cause indigestion.


Peptic Ulcers (Gastric ulcers and Duodenal ulcers)
There are two types of peptic ulcers, Gastric ulcers and Duodenal ulcers. Ulcers are breaks in the lining of the stomach or duodenum that can cause indigestion and complications like bleeding and perforation. Many ulcers are the result of chronic stomach infection with a bacterium called Helicobacter pylori which is treatable with antibiotics.


Hiatal Hernia
Hiatal Hernia is a set of conditions when a portion of the stomach rises up through an opening in the diaphragm into the chest and can cause chest pain or GERD. Watch this Webcast to learn more about Hiatal Hernia diagnosis and treatment.


Diagnostic Tools for Esophageal and Stomach Conditions

Upper GI Endoscopy (also known as EGD)
Upper endocscopy is a procedure where a flexible video endoscope is inserted into the mouth to look inside the upper digestive tract consisting of the esophagus, stomach and the first part of the small intestine (or the duodenum). Patients exhibiting symptoms of abdominal or chest pain, heartburn, nausea, vomiting, bleeding or swallowing problems may need to undergo an EGD to identify and treat their condition.

At the time of the procedure, tissue samples can be collected (this is called a biopsy) and abnormal growths (like polyps) can be removed. In addition to polyp removal, EGD allows patients to receive treatment for strictures of the esophagus, stomach, or duodenum (via balloon dilation or stent placement), as well as bleeding due to ulcers or cancer.


Upper GI Series
The patient drinks liquid barium and x-rays are taken of the esophagus, stomach and duodenum showing how they appear and function.


48-Hour Esophageal Reflux Monitoring by the Bravo Capsule
This tool, placed internally within the esophagus, assesses how much reflux takes place and how those reflux events relate to the symptoms that a patient experiences.


Endoscopic Ultrasound
This test uses a flexible endoscope with a small ultrasound probe attached to its tip to visualize organs, or to look at adjacent structures.


Esophageal Manometry
This test measures the pressure waves within the esophagus to detect overactivity or underactivity, and can measure the lower esophageal sphincter pressure.


24-hour Ambulatory Combined pH (acid) and Impedance Monitoring
Called the Sleuth System, this is the new gold standard for objectively assessing non-acid, as well acid reflux activity and can confirm significant gastroesophageal reflux disease. A tiny tube is placed through the nose and into the esophagus (above the lower esophageal sphincter). The test runs for 24 hours and measures the number of times acid enters the esophagus.


Biopsy
Pathologists analyze tissue removed at the time of endoscopy or surgery to diagnose many conditions.


Imaging
Scans such as ultrasound, CT (computed tomography), PET (positron emission tomography) or MRI (magnetic resonance imaging).


Blood tests


Treatment Options
Treatment strategies for esophageal and stomach conditions vary depending on the type of condition and its progression.

Lifestyle and Medication

  • Over-the-counter and/or prescription medicines, including antacids, acid suppressing agents and other drugs
  • Changes in diet and other lifestyle modifications
  • Nutritional guidance and other support


Surgery

  • Emergency endoscopy - to control bleeding and remove impacted food
  • Endoscopic resection - to remove cancerous and pre-cancerous tissue. The gastroenterologists at The Center for Digestive Health are part of a small number of U.S. physicians with expertise to remove the lining of the esophagus, stomach or duodenum endoscopically while leaving the organs intact.
  • Esophageal stents and balloon dilation of the esophagus - to open up the esophagus
  • Laparoscopic surgery - to strengthen the lower esophageal sphincter muscle in cases of reflux
  • Open or laparoscopic-assisted surgery - to treat more advanced cancers and other conditions not amenable to minimally-invasive techniques
  • Incisionless, surgical, endoscopic-assisted methods for the treatment of reflux, including EsophyX, which involves the use of devices that intensify and remodel the anti-reflux barrier at the level of the lower sphincter valve, and the TIF procedure, which reconstructs the anti-reflux barrier and gastroesophageal flap valve.
  • The BARRX ablation procedure - a safe and effective treatment for Barrett's esophagus resulting in an elimination of the abnormal tissue through the use of radiofrequency ablation


Other

  • Radiation or chemotherapy
  • Psychosocial services


To learn more about the many services provided by the Center for Digestive Health at Mount Sinai Beth Israel or to make an appointment for a consultation, please call
(212) 604-6822.

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