Esophageal and Swallowing Disorders Program

Esophageal and swallowing disorders can be complex. To make the most effective treatment plan, many experts are better than one.

The esophageal and swallowing disorders program brings specialists in gastroenterology, advanced endoscopy, foregut surgery, thoracic surgery and otolaryngology together to discuss patient cases and determine the most appropriate form of treatment. Ours is the only program in our region to offer this type of care for esophageal and swallowing disorders.

Additional factors that make our program exceptional include:

• Commitment to convenience. Many patients travel from out of town or out of state to see our team. We make our patients’ experiences as seamless and efficient as possible by coordinating visits with multiple specialists during their time in New Orleans. If you’re a candidate for surgery, we strive to limit the number of visits before your procedure. Overnight accommodations are available at the Brent House Hotel.

• Comprehensive team. Physician specialists aren’t the only experts who may be involved in your care. Our esophageal and swallowing disorders team includes speech-language pathologists, dietitians and specialized nurses.

• Leading-edge diagnostics. To create a personalized treatment plan for you, our specialists need to determine the precise nature of the problem. That’s why we use the latest guidelines and technology to offer comprehensive esophageal motility evaluation and GERD evaluation, including high-resolution esophageal manometry with impedance (a test that measures fluid movement and pressure in the esophagus while swallowing and at rest), EndoFlip I and II (devices that can measure the area and pressure of the esophagus), BRAVO pH testing (a swallowed capsule that measures the amount of stomach acid that gets into your esophagus), pH impedance testing (a catheter placed through the nose and into the stomach measures acidity changes), esophagogram (an X-ray imaging study of the esophagus) and endoscopic ultrasound (a test that combines a thin tube inserted into the mouth and sound waves to create images of the digestive tract

Based in New Orleans at Ochsner Medical Center - New Orleans, the esophageal and swallowing disorders program provides diagnostic and treatment services for residents of Louisiana, Mississippi, Alabama and beyond.

The esophageal and swallowing disorders program treats a wide range of conditions, which include:

• Achalasia — dysfunction of the lower esophageal sphincter that causes difficulty swallowing, chest pain and regurgitation (stomach contents flowing from the stomach into the mouth)

• Barrett’s esophagus — a precancerous condition that is diagnosed when tissue resembling the intestinal lining develops in the esophagus

• Chest pain and esophageal spasms — unusual contractions of the esophageal muscles

• Cricopharyngeal dysfunction — dysfunction of the upper esophageal sphincter, which lies between the esophagus and throat

• Eosinophilic esophagitis — accumulation of inflammatory cells in the esophagus

• Esophageal diverticula — pouches that develop in the esophageal muscle

• Esophageal spasms — unusual contractions of the esophageal muscles

• GERD — occurs when the lower esophageal sphincter, a muscle that acts as a gate between the esophagus and stomach, weakens. As a result, the muscle may not close properly, allowing stomach acid to enter the esophagus. This can cause heartburn, chest pain and other symptoms.

• Hiatal hernia and paraesophageal hernia — a part of the stomach moves up into the chest area through weakness in muscle

• Laryngopharyngeal reflux — when stomach acid irritates the voice box and throat

• Motility disorders of the esophagus — problems that can cause difficulty swallowing

• Scleroderma esophagus — severe weakness of the esophagus related to a connective tissue disorder

• Swallowing problems

Treatments for esophageal and swallowing disorders range from conservative options to advanced surgical procedures. Our program offers:

• Behavioral therapy. Working with a mental health specialist can reduce the emotional burden of an esophageal or swallowing disorder.

• Cricopharyngeal botulinum toxin injection. A Botox injection can reduce tightness in the upper esophageal sphincter.

• Cricopharyngeal myotomy. This procedure can loosen a tight upper esophageal sphincter.

• Endoscopic mucosal resection. A physician uses an endoscope, or probe, to remove abnormal tissue from the esophagus.

• Endoscopic and open treatment of Zenker’s diverticulum. Our team can perform an endoscopic procedure or surgery with an incision in the neck to treat Zenker’s diverticulum, a type of abnormal esophageal pouch.

• Esophageal dilation. If your esophagus is narrowed, this procedure stretches it out, which can help with difficulty swallowing.

• Esophageal stenting. A physician places a tube in the esophagus to help keep it open.

• Esophagectomy. This surgery to remove part or all of the esophagus may be necessary to treat esophageal cancer or end-stage achalasia, a rare swallowing disorder.

• Fundoplication. Surgeons often perform this surgery, which involves repositioning part of the stomach around the end of the esophagus, to treat GERD.

• Heller myotomy. This minimally invasive surgical procedure treats tightness in the lower esophageal sphincter.

• Lower esophageal sphincter botulinum toxin injection. A Botox injection reduces tightness in the lower esophageal sphincter (the muscle where the esophagus meets the stomach) for patients with spastic esophageal disorders that make it difficult to move food from the esophagus into the stomach.

• Medication therapy. A variety of medicines can treat esophageal and swallowing disorders. Proton pump inhibitors, for example, can treat GERD by reducing stomach acid production.

• Peroral endoscopic myotomy (POEM). This type of endoscopic procedure involves cutting the lower esophageal sphincter to treat achalasia and other esophageal muscle problems. It is less invasive and does not require any skin incisions.

• Pneumatic dilation. A strong balloon is used to disrupt the muscle fibers of the lower esophageal sphincter, which is too tight in patients with achalasia.

• Radiofrequency ablation for Barrett’s esophagus. Heat energy destroys cells in the esophagus that could turn cancerous.

• Speech and swallowing therapy. You’ll work with a speech-language pathologist to improve speaking and swallowing abilities.

• Stretta procedure. This minimally invasive procedure for GERD uses low-intensity heat to improve the functioning of the lower esophageal sphincter.

Ochsner’s esophageal program also offers revision surgery, which is a surgery that repairs or replaces a previous procedure that didn’t work. The ability to perform a revision surgery sets Ochsner’s program apart.

GERD affects more people than any other esophageal condition. About 20% of people in the United States may have GERD.

GERD often causes heartburn and regurgitation, which is when stomach contents rise through your esophagus and, potentially, all the way into your mouth.

To get food and liquid from your mouth to your stomach, your esophagus constantly contracts and relaxes as the food progresses down the tube. When you have achalasia, the lower esophageal sphincter (the ring of muscle at the bottom of the esophagus) doesn’t relax or the esophagus nerves becomes damaged. As a result, food can’t get into the stomach. Achalasia is usually managed with surgery or endoscopic procedures.

Yes. Virtual visits are available for Louisiana residents when appropriate.