Q&A: Advancements in treating esophageal disorders

Sajiv Sethi, MD, is a board-certified gastroenterologist and hepatologist with HonorHealth Gastroenterology. He specializes in the treatment of digestive-related medical conditions with a subspecialty in esophageal disorders. We recently sat down with Dr. Sethi to talk about the latest treatments available for esophageal disease.

Q. Who is at high risk for esophageal disease?

A: Esophageal conditions can affect patients of all ages. Adolescents and young patients commonly develop conditions such as eosinophilic esophagitis while middle-age and older patients can develop gastroesophageal reflux disease (GERD), esophageal strictures, rings and motility disorders, such as achalasia. Patients with conditions such as scleroderma, asthma and lichen planus are at a higher risk of developing swallowing disorders as well.

Q. How can you diagnose a patient with esophageal disease?

A: We have a variety of tools in our arsenal for the diagnosis and management of esophageal disease. Radiographic imaging such as a barium esophagram can often be a good first step. Most patients typically require endoscopy, which can be used for diagnosis and treatment.

At HonorHealth, we offer esophageal manometry for the diagnosis of motility disorders of the esophagus. Manometry is an excellent tool but can be difficult for some patients to tolerate. I am proud to be one of the few physicians in the nation to offer patients a sedated esophageal motility assessment alternative.

Q. Is there more to acid reflux therapy than medications?

A: Some patients have acid reflux not responding to medications, while others do not want to take medications due to side effects. Other may have symptoms such as non-cardiac chest pain, cough or Laryngopharyngeal Reflux (LPR).

I offer patients an objective esophageal acid measurement with placement of a temporary wireless pH probe into the esophagus. Based on the findings, we can confirm the presence or absence of acid reflux. Patients can then choose to continue medications or undergo definitive endoscopic or surgical treatment of GERD.

I also offer screening and treatment for Barrett’s esophagus and early-stage esophageal cancer.

Q. Why should patients see an esophageal specialist?

A: We now know that patients can often have esophageal disease that is not seen on an upper endoscopy (EGD) alone. Patients may have motility disorders, abnormal esophageal inflammation, non-acid reflux or impaired gastroesophageal relaxation, which all require advanced diagnostic techniques. I am pleased to offer patients the full range of diagnostic and treatment options right here in Scottsdale.

Q. Can you tell us more about the new technology you use for diagnosing esophageal disease?

A: Our latest device uses a lumen imaging probe and is performed during sedated upper endoscopy. In many cases, patients no longer have to undergo uncomfortable awake testing. This device gives us dedicated information regarding the mechanical properties of the esophageal wall and esophageal sphincter that helps evaluate esophageal motility disorders, eosinophilic esophagitis and esophageal strictures. We provide accurate esophageal characterization to offer personalized treatment options to patients rather than a one size fits all approach.

Q. What can patients expect when they visit an esophageal specialist?

A: At their visit, patients can expect an understanding of the potential causes of their symptoms along with a plan for diagnosis and treatment. Based on the patient's presentation, I choose the appropriate diagnostic modality to form a diagnosis. In many cases, we can diagnose and treat conditions in a single procedural session.

Q. What results can patients expect after treatment?

A: After treatment, patients can expect to see immediate improvement of their symptoms, such as difficulty swallowing, painful swallowing, heartburn or regurgitation. Occasionally, medications are an adjunct therapy to improve symptoms. However, for some patients a single therapeutic procedure can provide long-term symptom relief.

Q. Do you treat other GI conditions as well?

A: Yes, I pride myself on offering comprehensive GI care, including colon cancer screening.

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