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Normal gastrointestinal motor function is a complex sequence of events that is controlled by an external nerve supply from the brain and spinal cord, a complex network within the wall of the stomach and intestine (the so-called enteric brain), and the effects of locally released chemicals that alter the excitability of the gastrointestinal muscle. The clinical symptoms of disturbed gastrointestinal motility may be acute, recurrent, or chronic, and include loss of appetite, heartburn and acid regurgitation, difficulty swallowing, abdominal pain, distention, fullness and bloating, nausea and vomiting, constipation, fecal incontinence, weight loss, diarrhea, or alternating bowel habits. Gastrointestinal motility disorders, such as achalasia, esophageal spasm, gastroparesis, chronic intestinal dysmotility and defecatory disorders, affect ~15% of the population in Western countries and significantly compromise the patients’ quality of life and productivity.
The Silicon Valley Neurogastroenterology and Motility Center incorporates 20 years of unique professional experience with highly sophisticated and effective modern technologies to diagnose and manage gastrointestinal motility disorders. In addition to endoscopy, radiologic studies and specialized functional tests (esophageal, antroduodenal and anorectal motility, pH/impedance monitoring, Smartpill) we offer individually tailored pharmacologic therapies, biofeedback, endoscopic therapies (BoTox injection, radiofrequency Secca®, injection of Solesta®), and laparoscopic surgery (Enterra®, colonic resection) as indicated. Within the relaxed and private atmosphere of our office, the expert physician learns about the patient’s symptoms and signs that impair the patient’s quality of life, productivity and wellbeing. Following the performance of pertinent specialized diagnostic tests (endoscopy, colonoscopy, motility and radiologic studies), the physician explains the results and outlines an individualized therapy, which ranges from lifestyle measures, nutrition and eating behavior education, to medical, endoscopic and/or surgical treatments.
Gastro-esophageal reflux disease (GERD) may present with heartburn, acid regurgitation, difficulty swallowing, coughing, chest pain, wheezing or asthma, and affects 20-30% of the world’s population. GERD symptoms significantly impair the quality of life and productivity, may mimic heart disease, other esophageal conditions (achalasia, eosinophilic esophagitis) or disturb breathing or sleep. More importantly, GERD carries an increased risk for esophageal cancer development.
In the Acid Reflux Unit of the Silicon Valley Neurogastroenterology and Motility Center we use sophisticated and effective modern technologies to diagnose and manage GERD and prevent esophageal cancer development. In addition to endoscopy and esophageal function tests (manometry, pH/impedance monitoring) we offer individually tailored pharmacologic therapies, endoscopic radio frequency therapy (Stretta®), esophageal dilation and stenting of esophageal strictures, radio frequency ablation (HALO®) and endoscopic resection of Barrett‘s esophagus as well as laparoscopic antireflux surgery (magnetic ring LINX®; fundoplication).
The patient is also informed on the presence or absence of any relevant esophageal cancer risk and if cancer preventive strategies are needed. Within the relaxed and private atmosphere of our office, the expert physician learns about the GERD symptoms and signs that impair the patient’s quality of life, productivity and wellbeing. Furthermore, we perform an assessment of the esophageal cancer risk profile, which is the basis for cancer prevention.
Following the performance of pertinent specialized diagnostic tests (endoscopy, esophageal manometry and impedance/pH monitoring), the physician explains the results and outlines an individualized therapy, which ranges from lifestyle measures, nutrition and eating behavior education, to medical, endoscopic and/or surgical treatments. The patient is also informed on the presence or absence of any relevant cancer risk and if cancer preventive strategies are needed.
Medical therapy includes the use of antacids, proton pump inhibitors (PPI) and histamine 2 receptor blockers and works by blocking the stomach acid secretion thus reducing the acidity of the reflux. As a consequence, heartburn and acid regurgitation are eliminated in the majority of GERD patients. The type and dosage of the therapy are individually tailored according to the results of the diagnostic tests (endoscopy, histopathology, manometry, reflux monitoring) and the symptom response. Depending on the results of the clinical evaluation and testing, endoscopic dilation and/or stenting may be performed in patients with complicated GERD, esophageal cancer, achalasia or eosinophilic esophagitis. Such endoscopic interventions relieve the patients’ difficulty swallowing and provide a significant improvement in their quality of life. Because GERD results from the impairment of the competence of the lower esophageal sphincter, endoscopic radiofrequency treatment (Stretta®) may be applied.
Laparoscopic surgery works by improving the function of the sphincter by either wrapping the lower end of the esophagus with a portion of the stomach (fundoplication) or by placement of a magnetic pellets containing ring (magnetic sphincter augmentation, LINX®). The indication and type of antireflux surgery is decided based on the findings obtained from the diagnostic tests (endoscopy, histopathology, manometry, reflux monitoring).
Barrett’s esophagus affects ~10% of patients with GERD and carries a 0.5% annual cancer risk. Radiofrequency ablation (HALO®) is a novel, effective, minimally invasive, endoscopic procedure for durable elimination of Barrett‘s esophagus. This outpatient procedure takes 20-30 minutes and is performed under general anesthesia. It uses a balloon catheter (HALO® 360) or a focal, endoscope mounted, ablation systems (HALO® 60, 90), for the administration of radiofrequency energy to the esophagus, which destroys the abnormal Barrett’s mucosa. In special cases, the procedure may be combined with endoscopic resection of the Barrett’s esophagus. Optimal Barrett’s esophagus ablation is accomplished only after careful assessment of the disease burden and effective implementation of adjunct therapies against acid reflux, using medical, endoscopic or surgical therapies as needed.