The Digestive Health Center offers prevention, diagnosis and treatment programs for diseases of the esophagus, including:

• Gastroesophageal reflux disease (GERD)
• Barrett’s esophagus
• Esophageal cancer
• Achalasia, diverticula and other esophageal motility disorders

Gastroesophageal reflux disease (GERD)

Most people are unaware of the potential seriousness of GERD, yet it is the most common digestive disorder in the western world.

For patients with long-standing symptoms of GERD, referral to a gastroenterologist for an assessment of their esophagus is crucial. Signs of GERD may be a persistent cough, heart burn, chest pain, difficulty swallowing, asthma or hoarseness. Long term damage to the esophagus is associated with pain, inability to swallow, scarring and sometimes esophageal cancer. Early diagnosis and treatment can lead to prevention of progressive esophageal tissue damage.

Some patients require surgical treatment for GERD. Minimally invasive, laparoscopic fundoplication is an anti-reflux operation offered by our surgical specialists. This approach is well tolerated by patients resulting in reduced hospital stay, relief of symptoms and enhanced recovery. OHSU surgeons are also among the earliest to perform endoscopic surgery for reflux and continue to evaluate the benefits of this procedure. New treatments, such as, incision-less Esophy-X , radiofrequency treatment for GERD (STRETTA) and other endoscopic anti-reflux techniques that change the dynamics of the lower esophageal sphincter are also available.

Barrett’s esophagus

Promising new techniques to treat Barrett’s esophagus and prevent the development of cancer are offered by specialists in the OHSU Digestive Health Center. A major clinical trial studying radio frequency ablation of Barrett’s epithelium is under way. Other research focuses on chemo-prevention using medications to prevent the progression of Barrett’s esophagus toward cancer.

Esophageal cancer

Our physicians are studying new methods of diagnosis to aid in the identification of precancerous dysplasia and early cancer in patients with Barrett’s esophagus. Thin-caliber endoscopy without sedation may allow wide screening of “at risk” minimally symptomatic patients for Barrett’s esophagus. OHSU also provides the most advanced endoscopic ultrasonography services in Oregon for esophageal cancer, including the use of endoscopic ultrasound for the appropriate staging of cancer.

Patients with very early cancers can be treated with a novel procedure called endoscopic mucosal resection in which the portion of the lining that is diseased is removed using an endoscopic procedure. Stents may be used to enable patients with esophageal blockages to swallow. Surgeons at OHSU are pioneers in developing and performing the techniques of minimally invasive esophagectomy for selected patients.

Our radiation oncologists offer sophisticated treatment technology for patients with esophageal cancer, including the placement of catheters threaded to the site of the tumor to deliver a high dose of radiation. Radiation therapy may be used with curative intent or to relieve symptoms, such as an inability to swallow solid foods.

Achalasia, diverticula and other esophageal motility disorders

Achalasia is an unusual swallowing disorder. Diagnosis requires special expertise with esophageal manometry and other studies to rule out malignancy. Decisions to use endoscopic therapy (botulinum toxin or balloon dilation) or surgical myotomy are complex and benefit from the multidisciplinary approach of the Digestive Health Center. OHSU has historically treated most achalasia cases in Oregon, thanks to the expertise of its physicians and surgeons.