The Pelvic Floor Center

As part of the Digestive Health Institute, the Pelvic Floor Center offers a comprehensive diagnostic program for bowel incontinence and bowel movement disorders, one of only a few in the area.

Clinical Trials

Our physicians participate in a number of on-site clinical trials of newer treatments under development to help improve the future of medical and surgical alternatives for our patients. In some cases, participation helps provide early access to emerging therapies and technology.

It's your health. Own it.

For a physician referral or to request additional information about the Digestive Health Institute at Graduate Hospital, please call toll free at 1-877-7-GRAD-4-U (747-2348), or visit www.graduatehospital.com.

Caring for a Broad Range of Conditions

The GI tract is a complicated system - it seems that almost anything can throw it off balance, affecting your health and day-to-day activities. Our dedicated team of highly skilled physicians has special training and experience in medically and surgically treating a number of GI disorders, including:

• Barrett's esophagus
• Bowel incontinence
• Cancers of the esophagus, stomach, intestine, colon and rectum
• Crohn's Disease (colitis)
• Constipation
• Hemorrhoids
• Hepatitis
• Liver disease
• Gallbladder stones
• Gastroesophageal reflux disease (GERD or heartburn)
• Irritable bowel syndrome
• Pancreatic disease
• Polyps
• Strictures
• Swallowing problems
• Ulcers

Diagnosing the Problem

Diagnosing your GI disorder is an important first step to treatment. GI problems may be misdiagnosed without the proper screening procedure. The Digestive Health Institute's physicians begin with a comprehensive physical exam and follow up with blood tests, CT scan, MRI and/or ultrasound as appropriate. Other methods for diagnosis include:

Endoscopy

• EGD (esophageal gastroduodenoscopy) - Also known as an upper endoscopy, EGD uses a video endoscope to view and evaluate the upper gastrointestinal tract including the esophagus, stomach and upper duodenum. This procedure is used to diagnose and treat GERD, ulcers, stomach polyps and other conditions.

• Sigmoidoscopy - Recommended as part of a routine screening for older individuals, this procedure is used for viewing the rectum and sigmoid colon for the diagnosis of colon disease.

• Colonoscopy - Allows viewing of the lining of your colon (large intestine) for any abnormalities such as polyps.

• Endoscopic ultrasound - Used to help evaluate cancers of the stomach and pancreas. It allows for a detailed analysis of the depth and size of the cancer.

• ERCP (Endoscopic Retrograde Cholangiopancreatography) - ERCP is used to help diagnose disorders of the pancreas, bile ducts, liver and gallbladder. Stones or other blockages may be removed through the use of stents or extraction.

Manometry

• Esophageal manometry laboratory for motility and pH monitoring - Used for diagnosing swallowing disorders, the lab's capabilities extend to the evaluation and treatment of GERD.

• Ano-rectal manometry - This test measures the pressures of the anal sphincter muscles and how well the muscles function.

Advanced Technology for Comprehensive Treatment

At the Digestive Health Institute, our specialists work to help treat a patient's condition first with lifestyle changes, diet modifications, and/or medication. When these are not effective enough, other treatment options such as newer procedures or surgery may be explored. Patients are encouraged to seek treatment for GI conditions early to help avoid more complicated procedures. When appropriate, our surgeons use the least invasive method for intervention.

The Digestive Health Institute offers some of the latest advancements in surgical technology, including, but not limited to:

• Therapeutic endoscopy - There are a number of endoscopic treatments that employ the use of lasers, stents, ERCP, EGD scope and other tools to help treat bleeding sites, unblock ducts and remove stones. Therapeutic endoscopy allows physicians to diagnose and treat GI problems.

• Radiofrequency ablation - Using thermal energy, this procedure is used for the treatment of liver lesions and cancer, GERD and bowel incontinence. The Digestive Health Institute's physicians have a wealth of experience in radiofrequency ablation, and have participated in a number of clinical trials.

• Laparoscopy - Our surgeons have special expertise in laparoscopy (also known as minimally invasive surgery) for a number of conditions. Laparoscopic procedures include the laparoscopic Nissen for GERD, laparoscopic Heller for achalasia (swallowing disorder), laparoscopic colon resection for benign and malignant cancer and videoscopic surgery. Compared to tradition or "open" surgery, videoscopic surgery may help shorten hospital stays and recovery times.

For a physician referral, call toll free at 1-877-7-GRAD-4-U (747-2348).

___________________________________________________

Understanding Heartburn

Over 60 million Americans experience heartburn at least once a month and studies have suggested that over 15 million have symptoms every day.

Heartburn is a common, but not necessarily trivial condition. If you suffer infrequent heartburn, antacids or the newer over-the-counter remedies now available without a prescription may provide the relief you need.

But, if you are experiencing heartburn more than twice a week, or still have symptoms on your current medication, it may be more serious, You may have "acid reflux disease" (also known as Gastroesophageal Reflux Disease or GERD) which is potentially serious if not treated appropriately.

If you are self-medicating for heartburn more than 2 times a week, or you're still having symptoms on your over-the-counter or prescription medication, you should see your doctor. You may be referred to a gastroenterologist, a physician specializing in digestive diseases.

Your gastroenterologist may evaluate you for GERD. Using the range of prescription medications and other treatments available today, you may be able to become symptom-free, avoid potential complications, and restore the quality of life you deserve.

What is GERD?

Gastroesophogeal reflux is a physical condition in which acid from the stomach flows backward up into the esophagus. People experience heartburn symptoms when excessive amounts of acid reflux into the esophagus. Many describe heartburn as a feeling of burning discomfort, localized behind the breastbone, that moves up toward the neck and throat. Some even experience the bitter or sour taste of the acid in the back of the throat. The burning and pressure symptoms of heartburn can last for several hours and often worsen after eating food. All of us may have occasional heartburn, however, frequent heartburn (two or more times a week), food sticking after swallowing, GI tract bleeding or weight loss may be associated with a more severe problem known as Gastroesophogeal Reflux Disease.

Most people will experience heartburn if the lining of the esophagus comes into contact with too much stomach "juice" for too long a period of time. This stomach "juice" consists of acid, digestive enzymes, and other materials, which can be potentially injurious. The prolonged contact of these stomach juices with the lining of the esophagus injures the tissue in the esophagus and produces a burning discomfort.

Normally, a muscular valve at the lower end of the esophagus called the lower esophageal sphincter or "LES" keeps the acid in the stomach. In gastroesophageal reflux disease, the LES relaxes too frequently and allows stomach acid to reflux, or flow upward into the esophagus.

GERD can masquerade as other diseases or aggravate them. Patients with GERD may have chest pain similar to angina or heart pain. If your doctor has ruled out cardiac trouble and you have chest pain, it may be GERD. GERD may also be a cause of ear, nose and throat problems such as chronic cough, sore throat, frequent throat clearing or growths on the vocal cords. If these problems do not improve with standard treatments, GERD may be investigated as a cause. Patients may experience bleeding, vomiting blood, or have black tarry bowel movements. They may also experience shortness of breath, choking, coughing or hoarseness.

Complications of Longstanding GERD

Peptic Stricture: This results from chronic acid injury and scarring of the lower esophagus. Patients complain of food sticking in the lower esophagus. Stretching of the esophagus and proton pump inhibitor medication are needed to control the condition.

Barrett's Esophagus: A serious complication of chronic GERD is Barrett's esophagus. Here the lining of the esophagus changes to resemble the intestine. Patients with the condition may not have heartburn, but have a 30 times greater risk of developing esophageal cancer.

Evaluating and Treating GERD at the Heartburn Center at Graduate Hospital

Our interdisciplinary team uses a variety of techniques to diagnose your condition, including:

Esophageal Manometry which involves passing a small flexible tube through the nose into the esophagus and stomach to measure pressures and functions of the esophagus.

Esophageal pH which involves passing a very small flexible tube through the nose into the esophagus and stomach so that the degree of acid refluxed can be measured over 24 hours.

Upper GI Series in which you will swallow a liquid barium mixture and a radiologist will use a flouroscope to watch the barium as it flows down the esophagus and into the stomach.

Endoscopy which involves passing a small lighted flexible tube through the mouth into the esophagus and stomach to examine abnormalities. The test is usually performed with the aid of sedatives. It is the principal method to identify esophagitis and Barrett's esophagus.

Treatments for GERD

Some patients experience relief from lifestyle changes such as raising the heard of the bed and changes such as avoiding eating less than three hours before bedtime. Changing diet to foods which do not diminish the effectiveness of the LES may help. This includes avoiding especially fatty foods, chocolate and avoiding foods which irritate the lining of the esophagus (especially coffee, citrus juice and tomato juice).

Prescription Medication Treatments including

H2 receptor antagonists – Used since the 1970's, these are acid-suppression agents which improve heartburn and reduce the flow of stomach acid. They can help about 50% of patients with twice daily dosing, but healing of the esophagus may require higher dosing. These agents maintain complete remission of symptoms in about 25% of patients.

Proton pump inhibitors – These have been found to be effective in healing esophagitis more rapidly than H2 blockers. They provide not only relief of symptoms, but also promote healing. Studies have shown that these usually can promote healing of the muscosal tissues of the esophagus in 6 to 8 weeks in 75% or more of cases. They are significantly more expensive, however, than H2 receptors.

Promotility agents - These drugs increase lower esophageal sphincter pressure and prevent reflux. Symptoms are eliminated in about 50% of patients with twice daily dosing.

Other Treatment Options
When lifestyle and diet changes combined with medical treatment with drugs are not sufficient to return patients to the quality of life they expect, or patients cannot tolerate the medications, surgery may be an option. Surgery may be considered for any patient not achieving improved healing of damage to the esophagus with other methods, chronic bleeding, or recurrent stricture.

A variety of techniques are used to improve the natural barrier between the stomach and the esophagus. These include traditional surgical techniques and newer videoscopic techniques, which are less invasive and are appropriate for many patients.

Evaluation of the need for and appropriateness of surgery should be made after consulting with both a gastroenterologist and a surgeon experienced in the area of esophageal and LES repair.