Diagnosis and Treatment
We use advanced technology in our motility lab and endoscopy suite to diagnose GI conditions properly, which ultimately helps guide successful treatment.
- High Resolution Esophageal Manometry: A thin catheter with delicate pressure sensors is placed into the esophagus through the nasal passage. By recording the strength and coordination of contractions, your doctor can determine whether symptoms such as trouble swallowing, heartburn, or chest pain, is caused by abnormalities in the muscle function. This test can also be used to confirm whether certain surgeries on the esophagus or stomach are appropriate and safe.
- 24 hour pH-Impedance Testing: An even thinner tube is passed through the nose and into the esophagus to measure liquid movement passing between the esophagus and the stomach as well as the pH level. This test is used to determine whether you have reflux and whether it is acidic or “non-acidic.” This can be particularly helpful when patients have refractory reflux symptoms that are not responding to medication or if there is concern some non-classic GI symptom like chronic cough is caused by reflux.
- Ambulatory Wireless pH Study: During a sedated endoscopy, a small disposable pH-measuring sensor is placed onto the lining of the esophagus. Over the course of 48 to 96 hours, the sensor transmits to a monitor wirelessly about how much acid comes up into the esophagus. Afterwards, the sensor falls off and passes out of the body naturally.
- EndoFLIP®: Also known as endoluminal 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 while you’re sedated, your doctor places a catheter with a balloon mounted on the end into the esophagus. When inflated, the balloon can give information about the diameter of the esophagus as well as the contraction patterns of the muscle in response to the inflation.
Gastric and Small Bowel Testing:
- Wireless Motility Capsule: A pill-shaped sensor that measures temperature, pressure, and pH is swallowed. The sensor transmits to a small monitor which you wear for 5 days as you go about your regular activities. Once analyzed, this test will tell the doctor how quickly the pill passess through your stomach and small intestine, to help diagnose conditions like gastroparesis and small bowel dysmotility.
- Breath Tests: We perform hydrogen breath testing to evaluate for small intestinal bacterial overgrowth (SIBO). While this diagnosis is not unique to patients with motility disorders, some patients with motility disorders are predisposed to getting SIBO
- EndoFLIP: The same technology created for esophageal testing can also be used to measure the diameter of the pylorus muscle, which is sometimes affected in patients with gastroparesis.
Colonic and Pelvic Floor Testing:
- High-Resolution Anorectal Manometry and Balloon Expulsion Test: A small thin catheter with specialized sensors is inserted into the rectum. By performing various maneuvers like squeeze and “bear down”, your doctor can analyze whether there is proper strength and coordination, which can be abnormal in patients with constipation or fecal incontinence. A balloon is used to measure sensation as well as test the evacuation process.
- Wireless Motility Capsule: As described above, a pill-shaped sensor that transmits to a monitor is swallowed. The information gathered can measure the transit time of the colon, particularly helpful in patients who might have severe constipation.
Treatments We Offer
In addition to empathic and evidenced-based medical care, the providers at the Mount Sinai Center for Gastrointestinal Physiology and Motility offer unique endoscopic therapies and work closely with minimally invasive surgeons to offer multiple treatment options.
- Esophageal dilation: In a simple outpatient procedure, the GI endoscopist can stretch narrowings in the esophagus that may be a consequence of gastroesophageal reflux, eosinophilic esophagitis, or other conditions.
- Pneumatic Balloon Dilation: This is a specific dilation 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 movement through the esophagus..
- Transoral Incisionless Fundoplication (TIF): This is an advanced endoscopy procedure that doesn’t require surgery. TIF helps relieve acid reflux symptoms associated with chronic gastroesophageal reflux disease (GERD). A special device is fitted to the endoscope to recreate the body's natural barrier to reflux.
- Botox® Injections: This is a minimally invasive treatment for achalasia or gastroparesis. During an upper endoscope, your doctor injects Botox into the lower esophageal sphincter or pylorus muscle to relax the tightness associated with the disorder.
- Peroral Endoscopic Myotomy (POEM): This minimally invasive endoscopic surgical technique treats achalasia by cutting 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.
- Gastric Peroral Endoscopic Myotomy (GPOEM): Using the same technique as esophageal POEM, this advanced therapeutic endoscopy procedure is a treatment option for gastroparesis.
Minimally Invasive Surgeries
- We work closely with thoracic surgeons, bariatric surgeons, and general surgeons who you may consult with to discuss surgeries such as fundoplication, magnetic sphincter augmentation, roux-en-y gastric bypass or sleeve gastrectomy, and pyloroplasty.