"Physicians are all aware of the indications for testing for gastroesophageal reflux," says John Touliatos MD, with Advanced Surgeons. "But they may not know that we can now do the full evaluation for those patients in an office setting." Advanced Surgeons opened its Heartburn Center in an effort to provide a convenient and less expensive way of evaluating those patients who are not responding to medications, and possibly provide alternative treatment.
"Medications can reduce the amount of acid in the stomach, provide heartburn relief, and heal esophagitis. But they do not treat the root cause of the disease, which is a defective lower esophageal sphincter, and they may be masking other issues such as Barrett's esophagus, a pre-cancerous lesion," Touliatos says.
Over time, the reflux of stomach contents into the esophagus can damage the lining of the esophagus and cause the cells to become abnormal. This can occur in chronic sufferers of reflux despite medications. Testing for reflux generally requires a visit to the hospital or surgery center. However, the Heartburn Center at Advanced Surgeons offers an equivalent alternative without the complexities and costs.
Physicians at the center use a methodical approach to diagnosis and treatment which can contribute to a high success rate in identifying and addressing the root cause of heartburn, as opposed to just treating the symptoms.
Typically, the first test is an endoscopy which uses a scope to view the esophagus. This allows the physician to identify any pathology associated with disease such as a hiatal hernia, narrowing of the esophagus, or undertreated esophagitis. Performing this at a hospital would require sedation and take a significant amount of time. "We only need to spray some local anesthetic in the back of the throat, because we have smaller scopes," Touliatos says, estimating that the test can be done in as few as five minutes.
For patients who may want to consider surgery or have other alarm symptoms, the next test would be an esophageal manometry, which measures the effectiveness of the esophageal contractions and the position and function of the lower esophageal sphincter (LES). "In real time, it shows us the motor function of the esophagus, how strong the contractions of the muscle are, and if the LES relaxes normally," Touliatos says. This test can be run in ten to thirty minutes.
The manometry study also allows the physicians to identify where to place the test probe to measure the acid in the esophagus. This pH test can be as easy as attaching a tiny capsule, about the size of a pencil eraser, inside the esophagus that sends data to a cell-phone-size radio transmitter worn a belt by the patient for 24 to 48 hours.
In time, the capsule will dislodge and be passed without the patient even knowing it. "It's great for testing acid reflux and won't influence their daily routine," Touliatos says.
About ten percent of patients present with atypical symptoms that necessitates a more intensive pH test in which a tiny catheter is threaded through the patients' nose into the esophagus and is worn for 24 hours. This test not only measures acid, but also the direction of flow in the esophagus for those patients who reflux non-acid or weakly acidic fluid. It accomplishes this by adding impedance sensors to the catheter. Patients may actually be refluxing bile, which can be picked up by the catheter.
Touliatos says the biggest advantage to using the one-stop shop is convenience. "Patients can get in for testing usually faster than at a hospital," he says. "And the physician can run all the tests at the same time, sometimes on the initial visit. We typically get the results within 24 to 48 hours after the study is complete."
Advanced Surgeons does not do therapeutic endoscopy. "We use gastroenterologists for any therapeutic endoscopy, like polyp removal or endoscopic treatment of Barrett's esophagus," Touliatos says. "We are just evaluating reflux and offering surgical options.
"About 86 percent of patients have excellent long reflux control with only one surgery. So for people who are unhappy with their reflux not being controlled by medications, high costs of long term treatment, or side effects of medications, we have a discussion about the risks and benefits of surgery and let the patient decide."