Testing and treatment of upper GI disorders

Testing for upper GI disorders

The Gastroenterology specialists at Kelsey-Seybold commonly use the following tests to identify disorders of the upper gastrointestinal (GI) tract.

Esophageal Manometry

Determination of how the esophagus and sphincters (valves) work by measuring the pressure generated by the esophagus muscle and sphincters.

Esophageal pH Testing

A wired or wireless device is used to record acid reflux in patients not taking antacids. In the first method, a very thin tube with a pH electrode attached to its tip is passed 5 cm above the lower esophageal sphincter (valve) and the number of times and duration of acid reflux is measured for 24 to 48 hours. The other method uses the endoscopic placement of a tiny wireless electrode 6 cm above the sphincter and monitors for 48 hours. This is a standard method to identify patients with reflux that need treatment and to differentiate reflux from other causes of similar symptoms.

Barium Swallow X-ray (Esophagram)

Barium that shows up on X-ray (fluoroscopy) is swallowed and followed through the esophagus, stomach, and into the small intestine. This test is done for people who have trouble swallowing, or with stomach pain or heartburn. The test can find inflammation, motility disorders, strictures and stenosis, ulcers, and malabsorption.

Esophagogastroduodenoscopy (EGD)

An EGD is an endoscopy of esophagus, stomach, and upper small intestine that may include biopsy of abnormalities. In this minimally invasive procedure, a tube is inserted through the mouth to visualize the esophagus, stomach, and upper small intestine. Usually, sedation is used and the procedure lasts between 5 and 20 minutes. This test is performed to evaluate heartburn, GERD, difficulty swallowing, painful swallowing, or chronic nausea. EGD is also used to monitor patients with Barrett’s Esophagus, gastric or duodenal ulcer, or as a follow-up to surgery on the esophagus or stomach.

Esophageal Dilatation

This is usually done in combination with an EGD. In this procedure, esophageal strictures or rings are dilated to restore normal swallowing. The dilatations are done either over a guide wire utilizing a polyvinyl tube in graduated sizes, or by inflating special balloons in graduated sizes. In some cases, fluoroscopic guidance is used.

Gastric Emptying Time

This test measures the speed at which consumed food leaves the stomach and enters the small intestine. The patient consumes a safe, radioactive food and then a scan, similar to a Geiger counter, is placed over the abdomen. With normal gastric emptying, the test lasts less than 90 minutes. With delayed emptying condition, it could take six hours or more for the food leave the stomach. This test is performed for patients with upper abdominal pain or bloating and is often performed in patients with GERD to make sure the stomach empties.

Treatment of upper GI disorders

Our gastroenterologists use their expertise and a variety of methods to treat these common disorders of the gastrointestinal tract.

GERD (Gastroesophageal Reflux Disease and Hiatal Hernia with Symptoms)

Treatment for GERD and hiatal hernia is similar. In most cases, doctors will prescribe daily proton pump inhibitor (PPI) therapy (Aciphex, Nexium, Prilosec, Prevacid, or other similar drugs). These may be over-the-counter or prescription medications. In some cases, a nighttime H2 blocker (Tagamet, Pepcid, Zantac) and other drugs may be prescribed as well. Laparoscopic surgery (Nissen fundoplication) can be considered if the patient is non-responsive to primary treatment measures. Dietary and postural measures are also taken into consideration.

Barrett’s Esophagus, Esophageal Motility, Achalasia, and Diffuse Esophageal Spasm

Patients with any of these conditions require regular endoscopies with biopsy, especially high-risk patients. The condition is treated with regular use of medications to control acid reflux (H2 blockers, PPIs, antacids), non-steroidal anti-inflammatory drugs, endoscopic mucosal resection, or surgery. Esophageal strictures are treated by opening them up (dilating them) with either a weighted tube called a bougie or a balloon, and with proton pump inhibitor antacids.

Refractory Heartburn

When our specialists see patients who are suffering from refractory heartburn, they first discuss the food and beverages the patients regularly consume to determine if they may be causing the heartburn symptoms. Doctors may suggest short-term use of antacids like Maalox, Rolaids, or Gaviscon; however, these over-the-counter medications can cause health problems if taken on a daily basis, so doctors may prescribe H2 blockers or proton pump inhibitor therapy.