Esophageal and Motility Disorders Video and Transcript

Robert Burakoff, MD, MPH

  • Clinical Chief, Division of Gastroenterology, Hepatology and Endoscopy; Director, Center for Digestive Health, Brigham and Women’s Hospital
  • Professor of Medicine, Harvard Medical School

Esophageal and Motility Disorders – New Recommendations for Diagnosis and Treatment

There are 30 to 40 million people in the United States that complain of heartburn and indigestion that we will call gastroesophageal reflux disease. (Slide #3) Some people will actually present with having chest pain, or difficulty swallowing. Sometimes this can be due to acid reflux disease, but other times it can actually be due to an abnormality of how the esophagus contracts.

It can be that the esophagus is very weak, and the contractions are very slow and poor, and that allows the liquids and solids to hold up in the esophagus. We also have disorders where the esophagus contracts too strongly.

We also have some disorders where we lose a nerve in the esophagus at the end of the esophagus, and as a result the esophagus can't relax, and liquids and solids will sit in the esophagus, and the esophagus gets bigger and bigger.

Diagnosing Esophageal and Motility Disorders

At the Brigham and Women's Hospital in our GI motility center we're often doing testing which we call pH studies, as well as in endoscopy, where we can look in the esophagus, and you'll be able to see a picture of what a normal esophagus is.

How we actually diagnose these motility disorders of the esophagus---we pass a small tube through the nose into the stomach that allows us to record after you swallow liquids how well the esophagus contracts. We can determine if the esophagus contracts weakly, or we can determine if it contracts too strongly, or we can determine if the esophagus is contracting at the same time. We protect the esophagus by giving people the acid reducing medications, and asking them to eat slowly and not drink or eat too quickly. 

Treating Esophageal and Motility Disorders

We commonly treat people with heartburn and indigestion, and forms of chest pain with acid reducing drugs. People have heard about proton-pump inhibitors, we call them-- for example, omeprazole-- can block acid in the stomach. There's lots of foods that we have to avoid when we have reflux disease. For example, we're going to avoid fats, chocolate, caffeine.

We even try to avoid alcohol, which is important, because all these substances can weaken the esophagus sphincter that helps to prevent acid from coming up. In addition, why we like to lower fat, because fat can slow stomach emptying, and slow stomach emptying will also cause more acid reflux to occur.

Fortunately, over 90% of people in the United States will have their reflux disease completely well controlled by diet, though it's difficult to follow diets, as well as acid-reducing drugs, such as proton-pump inhibitors.

We can also have laparoscopic strengthening of the lower esophageal sphincter. There are also new techniques that have come along at Brigham and Women's Hospital, called the LINX procedure, which is a less invasive procedure to strengthen the sphincter in patients who have reflux disease who have no damage to the esophagus itself.

Multidisciplinary Care For Esophageal and Motility Disorders

At the Brigham and Women's Hospital in the GI Motility Center, we've been working at the cutting edge for people who have problems with swallowing disorders, as well as acid reflux, and very important non-acid reflux disease. And this is a collaboration not only in gastroenterology, but in the departments of Pulmonary, the Pulmonary Transplant, and Ear, Nose, and Throat.

Another area that's very important that we're doing research with the Division of Pulmonary Medicine at Brigham and Women's Hospital and Pulmonary Transplant Division at Brigham and Women's Hospital in association with the GI Motility Center is that by doing these recordings of acid and non-acid reflux at the end of the esophagus and the top of the esophagus, we can actually help to determine how much is the stomach contents that's coming up, acid or not, contributing to chronic lung disease. And we're doing studies which we've just recently presented, looking at these patients by doing these studies before a lung transplant to determine if acid or non-acid reflux is occurring, and if there is significant acid reflux, and if it cannot be controlled by acid reducing drugs, some patients actually may require surgery on the esophagus to strengthen their sphincter at the end of the esophagus that protects against reflux prior to a lung transplant.

And in the GI Motility Center, working with the Ear, Nose, and Throat Department, we can do these esophageal motility studies, as well as acid pH studies to look at acid and non-acid reflux by recording pH at the end of the esophagus and the very top of the esophagus to determine if non-acid or weakly acid, or acid is causing the problem with hoarseness, and with damage to the larynx.


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