difficulty swallowing Archives - Granite Peaks Gastroenterology of Utah

When Heartburn is More than Simple Indigestion

Posted on June 11, 2019September 12, 2019 by Christopher Cutler

How do you know when heartburn or “indigestion” is something more and needs to be treated? The gastroenterology specialists at Granite Peaks GI take time with their patients to determine if such symptoms may be a result of Gastroesophageal Reflux Disease (GERD). One of the red flags is heartburn occurring more than twice a week; although you can have GERD without the presence of heartburn. “If it is GERD, it needs to be diagnosed so further damage to the esophagus is minimized. There are also simple steps that can be taken to manage the disease and immediately improve one’s quality of life,” says Dr. Cutler, who explains more about the disease in the Q & A below.

What is GERD?

When we eat, food is carried from the mouth to the stomach through the esophagus. At the lower end of the esophagus where it joins the stomach there is a ring of muscle cells called the lower esophageal sphincter (LES). After swallowing, the LES relaxes to allow food to enter the stomach. Then, the LES contracts to prevent food and acid from traveling back up into the esophagus. GERD occurs when the LES weakens, allowing stomach contents and acid to back up into the esophagus, causing troubling symptoms or complications.

Who gets GERD and when should you see a doctor?

GERD affects ten million adults in the United States on a daily basis. People prone to developing it include those who are overweight, smokers or drinkers, and pregnant women. If symptoms are prolonged, or if you are unable to control the symptoms with lifestyle modifications and/or medications, you should see a gastroenterologist. Do so immediately if you have these warning symptoms: throwing up blood, passing black stool, difficulty swallowing, unexplained weight loss, or anemia.

What happens if you don’t treat GERD?

Untreated GERD may lead to the following complications: a narrowing of the esophagus which causes difficulty swallowing, ulcers which can cause bleeding, aspiration of acid into the lungs which may cause pneumonia or asthma, Barrett’s esophagus which is a precancerous lining of the esophagus, and esophageal cancer.

How is GERD treated?

Lifestyle modifications, such as the following, can help decrease symptoms: raising the head of the bed (placement of 6-inch blocks under the head of the bed), waiting at least three to four hours after eating before lying down, avoiding tight-fitting clothing, avoiding smoking and alcohol, losing weight, and eating smaller, more frequent meals. Foods that can commonly aggravate GERD include: fatty foods, chocolate, peppermint, alcohol, caffeine, and citrus drinks. There may be other foods specific to each patient. Medication can also be used to help treat this condition, including antacids such as Mylanta or Maalox, H2 blockers such as Zantac or Tagamet, and proton pump inhibitors (PPIs) such as Prilosec or Prevacid.

How is GERD diagnosed?

Your doctor may be able to diagnose this condition based upon your symptoms and response to therapy. If you have any of the classic warning symptoms mentioned above, your doctor may recommend an upper endoscopy. An upper endoscopy is a painless procedure performed under moderate sedation where a tiny lighted camera is passed through your mouth into your esophagus. Your gastroenterologist will be able to see whether there is damage to your stomach or esophageal tissue, and will be able to recommend a treatment plan to address your specific condition.

Talk to the experts at Granite Peaks Gastroenterology at our Sandy or Lehi office to help relieve your symptoms and determine the best course of action to treat your GERD.

Esophageal Motility Disorders: Treatment and Diagnosis

Posted on February 5, 2019April 18, 2019 by James Stewart

By James M. Stewart, MD

Difficulty swallowing (dysphagia) is a common problem that many people experience. Oftentimes, trouble swallowing is caused by acid reflux or even a small, but harmless, narrowing of the esophagus may cause food to stick in the throat. These conditions are usually assessed with an upper endoscopy where a dilation of the esophagus may be necessary. The diagnosis of acid reflux may require pharmacological control to improve swallowing mechanisms. However, there are some rare causes of dysphagia that do not respond to these techniques.

In order to swallow properly, a very coordinated series of muscle contractions must occur in order to move food from the back of the mouth and into the esophagus. Then a different set of muscle contractions further progress the food through the esophagus and into the stomach. Relaxation of the sphincter muscles (which act as valves) has to synchronize with the muscle contractions in order to move the food through the esophagus. As one might imagine, there are many opportunities for these muscles to function improperly, resulting in a feeling of strain or discomfort when swallowing.

Diagnosing Esophageal Motility Disorders

The best method of diagnosis for muscular disorders of the esophagus is through a test called a HIGH RESOLUTION ESOPHAGEAL MANOMETRY. This process involves placing a small catheter (tube) that contains multiple pressure sensors into the esophagus. The patient is then given a slightly salty sip of water to drink which activates a swallowing response. The manometry machine then records the measurement of pressure on each of the tube’s sensors. The observed patterns are then compared to what is considered a normal swallow. The differences can help show which area may not be functioning at an optimal level, and how to best address the issue. This test process takes about 30 minutes to complete. Esophageal muscular dysfunction of this level is not typical; therefore, this test is not a routine recommendation until after a patient has had an upper endoscopy and has also tried other therapy options first.

Treating Esophageal Motility Disorders

Since an esophageal manometry can diagnose many different muscular causes of difficulty swallowing, treatment largely depends on what the test shows as abnormal function. Sometimes surgery is indicated to open a part of the esophagus that may not appropriately relax, sometimes medications can be used to help the esophagus contract more vigorously or more gently, depending on the abnormality.

If you are experiencing difficulty when swallowing, make an appointment with one of the gastroenterology specialists at Granite Peaks GI for a proper evaluation and diagnosis. A full range of treatment options are available to appropriately address your needs for this condition.

Understanding and Treating Dysphagia

Posted on December 12, 2017April 18, 2019 by Steven Desautels

By Dr. Steven G. Desautels

Dysphagia refers to difficulty swallowing. Dysphagia can be subdivided into: oropharyngeal dysphagia and esophageal dysphagia.

Oropharyngeal dysphagia is characterized by difficulty initiating a swallow, transferring the food bolus or liquid into the esophagus, and/or the association of coughing and choking during attempted meal consumption.

Many disorders cause oropharyngeal dysphagia (see below from UpToDate 2017). Generally, these include neuromuscular diseases, systemic diseases, and mechanical obstruction. Common symptoms in oropharyngeal swallowing disorders include recurrent bouts of aspiration pneumonia from inadequate airway protection, hoarseness, and nasal regurgitation.

The primary treatment of oropharyngeal dysphagia is swallowing rehabilitation by a swallowing professional, a speech pathologist. Patients who have oropharyngeal dysphagia due to an anatomical abnormality, such as a Zenker diverticulum usually require endoscopic or surgical intervention.

Esophageal dysphagia is characterized by the onset of symptoms after the initiation of a swallow. The normal function of the esophagus is to transfer food and liquid. Esophageal dysphagia can be caused by several diseases (see below from UpToDate 2017) but is most often related to a mechanical obstruction. Esophageal dysphagia caused by a motility disorder is commonly characterized by dysphagia with both solids and liquids. Dysphagia associated with only solid foods is more likely due to a mechanical obstruction, although a mechanical obstruction may progress to the extent that dysphagia is associated with both solids and liquids.

Esophageal dysphagia is an alarm symptom and warrants consultation with a Gastroenterologist and subsequent investigation with an upper gastrointestinal endoscopy and possible esophageal manometry (motility test). The goal of testing is to identify structural or mucosal abnormalities that require intervention, to detect underlying systemic disease, and to define functional disorders. The association of liquid dysphagia merits manometry evaluation.

Broadly speaking, esophageal motility disorders are classified into achalasia and related disorders (eg, diffuse esophageal spasm) and nonspecific disorders (eg, jackhammer esophagus). Achalasia is the loss of peristalsis of the esophageal body and failure of relaxation of the lower esophageal sphincter. Achalasia is the best established of the motility disorders, with defined and effective treatments. Most other esophageal motility disorders have questionable associations with clinical symptoms and few effective treatment options.

If you experience frequent choking or have difficulty swallowing, contact our office for evaluation of your symptoms by any of our board-certified gastroenterologists.