What Your Gut Should Tell You: Esophageal Health Requires an Experienced Team

Reflux and other esophageal issues require prompt diagnosis and treatment to prevent more serious health concerns, including chronic indigestion or rarely, cancer. The Esophageal Center of Excellence at Virginia Mason brings a multidisciplinary approach to treatment that includes experts in interventional radiology, oncology, nursing and pathology.

“Multidisciplinary care allows us to provide the treatment that is most appropriate and most effective,” says gastroenterologist Andrew Ross, MD.

stomachePublished outcomes show that innovative care at the Esophageal Center results in shorter hospital stays, better cancer survival rates and a better quality of life after surgery. “Our excellent outcomes are attributable to our commitment to clinical research and publication,” says Donald Low, MD, director, Esophageal Center of Excellence. “We are always on the forefront of research that allows us to use the newest and best treatments.”

Virginia Mason has the highest volume of esophageal resections in the Pacific Northwest, with 75 percent of patients traveling 150 miles or more to receive care. Esophageal specialists also developed the only anti-reflux procedure originating in North America.

GERD and Acid Reflux

The Esophageal Center is known for its innovative and successful treatment of the related conditions of acid reflux and gastrointestinal reflux disease (GERD), a chronic condition frequently caused by inappropriate relaxation of the lower esophageal sphincter.

GERD requires prompt treatment to avoid additional health problems that include esophageal ulcers, chronic cough, irritation of the esophagus and other serious conditions. Smoking, obesity, pregnancy and certain medications may predispose a person to experience GERD.

Symptoms of GERD include the sensation of a lump behind the breastbone, nausea after eating and heartburn. GERD is treatable in the overwhelming majority of patients with dietary and lifestyle changes, medications and/or surgical intervention.

Medications generally work by making the stomach juices less acidic. They do not fix the underlying reason for GERD, which leads to a recurrence in symptoms once medications are stopped.

There have been some controversial studies regarding the safety of long-term use of some medications to treat GERD. It is best for patients to rely on the lowest possible dose that results in control of symptoms. Concerns regarding calcium metabolism and osteoporosis mean that patients using these medications for longer periods may need to have their bone density monitored, and should check with their physician to see if tests are indicated.

Long-term GERD can, in rare cases, lead to the development of esophageal cancer. Patients with long-term (greater than 5-10 years) of symptoms, especially middle-aged white men, should ask their doctor about undergoing an endoscopy to evaluate for pre-cancerous changes of the esophagus. Patients who develop difficulty swallowing, weight loss, blood in the stool or anemia should see their doctor immediately.

Barrett’s Esophagus

Barrett’s Esophagus is a condition of GERD that occurs when the tissue in the esophagus begins to take on the characteristics of the tissue in the intestines. Although this is considered a pre-cancerous condition of the esophagus, most patients with Barrett’s esophagus will never develop esophageal cancer in their lifetime. In patients with Barrett’s esophagus, routine exams of the esophagus and upper digestive systems may help ensure that any cancerous or pre-cancerous cells are found and treated early.

Esophageal Cancer

Esophageal cancer patients who have undergone surgery at Virginia Mason have some of the best reported outcomes in the world. An analysis of one 20-year period (1991-2011) showed a postoperative mortality rate of less than 0.5 percent compared to the national rate of 8.9 percent.

In addition, recent data from the National Cancer Data Base demonstrate that patients at Virginia Mason have better esophageal cancer survival rates at every stage of the disease. Physicians from around the world have visited Virginia Mason to study the clinical pathways that have led to the best possible management of esophageal cancer.

This management includes regular multidisciplinary cancer conferences and support groups that benefit patients, physicians and staff, who gain better insight into and understanding of specific esophageal disorders. At Virginia Mason, care supported by an esophageal cancer nurse navigator and continuous communication help ensure the best results, and ultimately the best quality of life for patients.

The Esophageal Center of Excellence provides comprehensive care for a range of esophageal and gastrointestinal issues. If you have questions or are experiencing symptoms, please call us at
(206) 223-2319.

Ask a GI Dietitian: Staying Healthy This Summer

by Samantha Woodward, Digestive Disease Institute **

Debra Clancy, RD, CD, is a registered dietitian who works with patients within Virginia Mason’s Digestive Disease Institute providing nutrition information and tools for making positive changes in their lives. In a recent chat, she gave us the inside scoop on how to make healthy choices when you are out and about this summer and surrounded by meat in buns and ice cream on cones.

If I’m trying to stay healthy this summer, what types of foods should I eat more of and what foods should I avoid?

Clancy: Instead of avoiding some of your favorite summer foods, modify their ingredients and eat smaller portions. Make small, but significant, changes to summer food recipes like decreasing fat and sugar content by using low-fat products or decreasing the amount of sugar in a recipe.

A healthy summertime meal from the grill.

A healthy summertime meal from the grill.

The typical summer gathering with family and friends lasts for several hours, so try going back to the buffet more often, each time taking small amounts of food instead of overfilling your plate on a single trip. Choose side-dishes, salads that have a vinaigrette dressing, or very little mayonnaise, and meat items that have the skin removed or have minimal sauce covering them.

At your next ballgame, don’t order deep-fried foods – or try to split a dish with someone. Other healthy choices include ordering a smaller size beverage or water. When it’s time for dessert, try a small amount, scrape off the frosting and eat just the cake or choose a fruit dish instead. Choose mineral waters or flavored waters instead of sugar-sweetened beverages.

Don’t forget to exercise by walking and participating in activities that increase your heart rate for at least 30 minutes daily.

What food choices can I make to help prevent indigestion?

Clancy: If you are prone to indigestion, the symptoms are often increased when a large meal is spicy, acidic or high in fat. Spicy foods may be the BBQ sauce on the grilled chicken breast. Tomatoes are examples of acidic foods. High fat foods include cream dishes, deep-fried items and salads with lots of mayonnaise.

Follow these simple tips to minimize heartburn:

  • Eat green salads with minimal dressing, skinless turkey and chicken, fish and seafood, melons and bananas, and root vegetables, such as carrots and potato.
  • Choose low-fat dairy products as supplements to the meal, not as the main item.
  • Eat small amounts of food over a number of hours during the event.
  • Remain sitting upright for one to two hours after each meal.
  • Avoid carbonated sodas, alcohol, chocolate and large amounts of caffeine.
  • Weight loss often improves indigestion symptoms and decreases the progression to GERD, or gastroesophageal reflux disease.

Indigestion becomes GERD when your discomfort lasts for a longer period of time or when it occurs with each meal. If you are following the above suggestions and your symptoms persist, it’s best to seek medical advice.

When it’s your turn to be the host this summer, search online for healthy alternative recipes for your favorite foods:

Enjoy your summertime BBQ’s and events!

7 Ways to Prevent GERD

Gastroesophageal reflux disease (GERD) can wreak havoc on your body and ruin a food-filled celebration. While there are very successful medical treatments for GERD, many times you can actually prevent GERD from happening in the first place:

  1. Eat smaller, more frequent meals. A full stomach can put extra pressure on the esophageal area, which will increase the chance that some of this food will reflux into the esophagus.
  2.  Limit your intake of acid-stimulating foods and beverages. Many foods such as citrus juices, onions and high-fat red meats can cause your body to produce more acid, while safer foods such as apples, whole grains and low-fat white meats are better for you.
  3.  Don’t go to bed with a full stomach. Having your last meal at least two to three hours before bedtime allows your body to digest foods and results in acid levels going down before you call it a night.
  4.  Maintain a reasonable weight. Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus. Even a 10 percent decrease in body weight can do wonders for preventing GERD.
  5.  Quit smoking. Smoking also stimulates the production of stomach acid and can cause muscles in the esophageal area to relax, causing GERD. If you smoke, speak with your provider about proven ways to quit the habit.
  6.  Avoid alcohol. Alcohol can irritate the lining of your stomach and cause overproduction of stomach acids. If you suffer from GERD, consider eliminating alcohol from your diet and drink water, which reduces symptoms of GERD.
  7.  Keep a heartburn record. Record what triggered your acid reflux episodes, the severity of each episode, how your body reacts and what gives you relief. You can take this list to your provider to help develop a plan for managing GERD, so you can enjoy food and activities without the burn.

Are you curious what causes GERD and how different foods affect Gastric Gayle? Play Reflux: The Food Impact Game, an interactive game that can help you make the right food decisions.


This article originally ran in Team Medicine NewsFlash.