Diagnosis and Treatment
In order to treat your gastrointestinal (GI) motility disorder and restore your quality of life, you first need a proper diagnosis for conditions like achalasia that affect the way the muscles of your esophagus function. Mount Sinai gastroenterologists who specialize in motility disorders are experts in administering the highly specialized tests required.
Diagnosis of Motility Disorders
We perform advanced therapeutic endoscopic procedures and the following specialized tests to diagnose motility disorders.
- Acid Reflux Testing (Ambulatory pH Wireless Study): We place a disposable pH-measuring wireless capsule on the lining of the esophagus during a routine endoscopy. Over the course of 48 hours, this pH sensor sends diagnostic data about the acid in the esophagus to a small computer. Afterwards, the capsule passes out of the body through the stool.
- EndoFLIP®: Also known as endolumenal functional lumen imaging probe, this is one of the newest, minimally invasive tests available for diagnosing esophageal motility disorders like achalasia. During a regular endoscopy, your doctor places a catheter with a balloon mounted on the end into the esophagus. Mild electrical impulses move through the balloon, measuring how well the esophagus swallows food.
- Gastroesophageal Reflux Testing (Ambulatory pH Impedance Technology): This test requires the expertise of our specialists and is not available widely. To perform the test, your doctor gently passes a tube through the nose and into the esophagus to measure the pH level and movement of liquid passing between the stomach and the esophagus. This process is especially important if you have reflux symptoms to determine if you have bile reflux or non-acid reflux, to assure that you get the right treatment for your specific type of reflux.
- Gastrointestinal Transit: Your doctor measures the rate at which material leaves the stomach, moves through the intestines, and goes out through the rectum. A smart pill wireless capsule, scintigraphy, or radiopaque marker tracks how your GI tract is functioning.
- High-Resolution Anorectal Manometry and Balloon Expulsion Test: This test measures the sensation, strength, and coordination of the rectum during bowel movements (evacuation). The test assesses the causes of evacuation disorders and bowel incontinence.
- High Resolution Esophageal Manometry Studies with Impedance Technology: Your doctor places a thin catheter in your esophagus through your nose. By recording the contractions of the intestinal muscle, your doctor can determine the strength and coordination of the esophagus muscle. The test also shows how food moves through your digestive tract.
Treatments We Offer
When you have a gastrointestinal (GI) motility disorder, your concern is to relieve your symptoms and restore your quality of life. Through advanced endoscopy or minimally invasive surgery along with nutritional planning or psychological support, we can help you.
In addition, at Mount Sinai, we offer specialized treatments for evacuation disorders and bowel incontinence. Our specialists in advanced therapeutic endoscopy provide treatments for motility disorders.
Our range of motility treatments is extensive and customized based on your specific needs. We offer treatments for both upper and lower GI motility disorders.
Upper GI motility disorder treatments
- Botox® Injections: This is a minimally invasive treatment for achalasia. Your doctor injects Botox into the lower esophageal sphincter to relax the tightness associated with the disorder.
- Heller Myotomy: Your surgeon makes laparoscopic incisions in the lower esophagus and stomach to treat achalasia by reducing pressure so food can pass more easily to the stomach.
- LINX® Reflux Management System: A treatment for gastroesophageal reflux disease (GERD). The device is small expandable ring of linked magnetic beads that your doctor laparoscopically implants at the junction of the esophagus and the stomach. It prevents stomach fluid from entering through the lower esophagus and enables normal swallowing.
- Peroral Endoscopic Myotomy (POEM): This minimally invasive surgical technique treats achalasia by relaxing the muscles of the esophagus. A member of our advanced therapeutic endoscopy team typically performs the procedure during an endoscopy by making small incisions from the inside, with no visible scarring. The process takes approximately two hours. For a day, you remain in the hospital so we can monitor your condition and give you intravenous antibiotics.
- Pneumatic Balloon Dilation: This is an endoscopic therapy for achalasia. Treatment involves an air-filled balloon that your doctor inserts into the esophagus using a catheter during endoscopy. The balloon is inflated, and the pressure from it helps to expand the opening in the lower esophagus to relieve tightness that was preventing proper digestion.
- Transoral Incisionless Fundoplication (TIF): This is an advanced endoscopy procedure that doesn’t require surgery. TIF relieves acid reflux symptoms associated with chronic gastroesophageal reflux disease (GERD). Your doctor gently inserts an endoscope through a special TIF device to repair or recreate the body's natural barrier to reflux.
Lower GI Motility Disorder Treatments
- Anorectal Biofeedback Therapy: This treatment program uses neuromuscular conditioning techniques to treat fecal incontinence or chronic constipation associated with dyssynergic defecation.
- Sacral Neuromodulation: This restores coordination between the brain, pelvic floor, bladder or bowel, and sphincter muscles. Your doctor surgically implants a small device about the size of stopwatch in the buttocks. It stimulates the appropriate nerves by using mild or moderate electrical impulses to treat the symptoms of bowel incontinence and chronic constipation. The Food and Drug Administration approves it for treatment of bowel incontinence.
At Mount Sinai, we work collaboratively to give you the best possible care for GI motility disorders. We are constantly exploring new options that will help restore your quality of life and relieve your symptoms.