Esophageal Institute at AHN

For the final paper from this month’s edition of “Foregut, the Journal of the American Foregut Society,” we return to another article written by our own Dr. Shahin Ayazi. His article is here:

Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility
https://journals.sagepub.com/doi/full/10.1177/26345161211044448

It’s available free to read or download for a limited time.

In it, Dr. Ayazi takes a deep dive into the function of manometry: How it developed, why it is essential to diagnosis of esophageal motility disorders, and how, if read properly, manometry can guide surgeons and patients to choosing the appropriate surgery and surgical techniques for optimal outcomes. He further discusses the utility of manometry as a predictor of a patient’s post-surgical performance.

Dr. Ayazi practices at West Penn Hospital.

Congratulations to Dr. Ayazi and Dr. Grubic on all their contributions to this month’s “Foregut”!

Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility - Shahin Ayazi, 2021 Manometric assessment of the gastroesophageal junction (GEJ) and esophageal body is the key to a better understanding of the mechanics of antireflux surgery (AR...

This month's issue of "Foregut, the Journal of the American Foregut Society," is all about esophageal motility. The second of three articles we're making available this week was co-written by our friend, colleague, and graduate Fellow, Andrew Grubic. DO.

Evolution of Esophageal Motility Testing: From Kronecker to Clouse
https://journals.sagepub.com/doi/full/10.1177/26345161211044151
The article is free to access or download for a limited time.

Dr. Grubic’s article, written in collaboration with Dr. Peter F. Crookes of the University of Southern California, provides an excellent history of motility testing as well as a discussion of the development of high-resolution manometry. Drs. Grubic and Crookes also present thoughts on the relationship of manometric testing to accurate diagnosis.

Dr. Grubic's practice is based at St. Vincent's Hospital in Erie, PA.

Evolution of Esophageal Motility Testing: From Kronecker to Clouse - Andrew D. Grubic, Peter F. Crookes, 2021 Esophageal motility, the science of quantifying the mechanical function of the esophagus, was initiated by Hugo Kronecker in Germany in 1882. Little progress wa...

The Esophageal Institute is pleased to share that the third issue of "Foregut," the Journal of the American Foregut Society, is now available! This issue is themed around esophageal motility, featuring 14 papers covering different aspects of motility disorders. The preface article was co-authored by our own Dr. Shahin Ayazi:
Esophageal Manometry and Science and Practice of Esophagology
https://journals.sagepub.com/doi/full/10.1177/26345161211044975
It is available for free to access or download for a limited time.

The entire issue can be found here: https://journals.sagepub.com/toc/guta/1/3

Dr. Ayazi’s preface offers a great overview of esophageal manometry and is an excellent resource for anyone wishing to learn more about the science and utility of this essential diagnostic procedure.

Of the fourteen papers, another two were authored by Allegheny Health Network Esophageal Institute staff or graduates. We’ll share additional titles over the coming days.

Check out the issue and Dr. Ayazi’s article today!

Preface: Esophageal Manometry and Science and Practice of Esophagology - Shahin Ayazi, Kaveh Hajifathalian, 2021 If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box.

THANKS TO ALL OUR DONORS!

On July 15, Highmark Health wrapped up its 2021 Virtual Highmark Walk for a Health Community.

Thanks to your generous donations, the Esophageal Institute raised over $3,100 for our Esophageal Cancer Patient & Family Fund. These funds will be used to benefit patients with a new diagnosis of esophageal cancer.

We truly appreciate everyone’s support, especially during these continuing difficult times. This is a strong foundation on which to build the Fund.

We hope to be able to celebrate this year’s success, remember and honor our loved ones, and connect with our patients and their friends and families, as well as our friends and family, at a live 5K event next April, during next year’s Esophageal Cancer Awareness Month.

Over the coming weeks, our office will receive t-shirts and contact information for the participants who qualified for them. We will distribute them from our office; we appreciate your patience while we get the items organized and sent.

Once again, our deepest gratitude to all those who gave generously to support this effort! Great job, everyone!

Back in person and better than ever! Registration is now open for the AFS Annual Meeting! We will be IN PERSON for 2 1/2 days at the Ga***rd Opryland in Nashville, TN. 19 CME/MOC credits will be offered. Register here: http://ow.ly/GUVI50EPMhe

ICYMI: Dr. Blair Jobe spoke with Lynne Hayes-Freeland yesterday on 100.1 FM and AM 1020 KDKA! They talked about esophageal cancer in the context of maximizing men’s health.

You can access the interview here:
https://www.audacy.com/kdkaradio/podcasts/lynne-hayes-freeland-20942/dr-blair-jobe-is-the-director-of-the-esophageal-and-lung-institute-at-ahn-371801300

As we round out Esophageal Cancer Awareness month, Dr. Jobe and Lynne Hayes-Freeland discuss how little is known about why it affects more men than women. Dr. Jobe also talks about risk factors, and ways to minimize some of those risks. Did you know that 40% of patients develop esophageal cancer without experiencing any symptoms?

Remember that registration for the Highmark Walk for a Healthy Community is still open through July 15! Esophageal Cancer month may be drawing to a close, but you can still support our teams and donate to our Patient and Cancer Family Fund by participating here: hcf.convio.net/EIEC2021

Thanks to the team Allegheny Health Network and to KDKA and Lynne Hayes-Freeland KDKA for helping raise awareness about esophageal cancer!

Dr. Blair Jobe Is The Director Of The Esophageal And Lung Institute At AHN. Maximizing Men’s Health Segment, Dr. Jobe Is A Nationally Renowned Pioneer In The Field Of Minimally Invasive Surgery And Endoscopic Therapy For The Treatment Of Esophageal Cancer, Barrett’s Esophagus, Esophageal Mobility Disorders And Gastroesophageal Reflux Disease (GERD). The Topic Of Convers...

Ask a Doc: Esophageal Cancer | Highmark Health Blog In our Ask a Doc series, we sit down with physicians and other clinical experts, including those at Allegheny Health Network (AHN), for a chat on an important health topic. In this interview, Dr. Blair Jobe discusses esophageal cancer.

Esophageal Cancer Awareness Month continues! This morning, Dr. Jobe was featured on the The KDKA Radio Morning Show with Larry Richert and Kevin Battle!

In case you weren’t listening this morning, you can hear the full interview here:
https://www.audacy.com/kdkaradio/podcasts/the-kdka-radio-morning-show-with-larry-richert-and-kevin-battle-268

Larry and Kevin speak with Dr. Jobe about the risks of esophageal cancer, how and when to get tested, and the difficulty of getting men to see their doctors.

Thanks to KDKA Radio and Allegheny Health Network for helping us highlight Esophageal Cancer Awareness Month, and congratulations on a great interview, Dr. Jobe!

Remember that you can still register for the Highmark Walk for a Healthy Community and support the Esophageal Institute’s Cancer Patient and Family Fund by going here: hcf.convio.net/EIEC2021

Donations made to the Esophageal Cancer Patient and Family Fund will help newly-diagnosed patients defray some of the costs of treatment that are not typically covered by insurance. This includes things like nutrition support pre- and post-surgery, and may include some of the costs associated with getting to their treatment appointments. Registration is open through July 15.

The KDKA Radio Morning Show With Larry Richert And Kevin Battle On-Demand Selections From The KDKA Radio Morning Show With Larry Richert And Kevin Battle On Newsradio 1020 KDKA, Airing Weekdays From 5am To 9am.

April is Esophageal Cancer Awareness Month!

To kick off this month of spreading awareness, Dr. Jobe sat down with Emily Laubham of Highmark Health for their “Ask a Doc” series. You can read the interview here:
https://www.highmarkhealth.org/blog/care/Ask-a-Doc-Esophageal-Cancer.shtml

They discuss the link between reflux and cancer, the kinds of interventions and diagnostic processes that help identify the presence of cancer and pre-cancerous conditions, and emerging technologies that offer some hope for earlier intervention and better treatment.

Here’s a short excerpt:
Emily Laubham: It sounds like this cancer is still shrouded in a bit of mystery. What is promising in terms of research to understand it or future advances?

Dr. Blair Jobe: There’s a lot of work to be done, but also amazing things already being done. What we really need to be able to do is draw someone’s blood to know if they have cancer in their bloodstream. The blood test is the holy grail for us.... [I]mmunotherapy — a way of enhancing the immune system to attack and fight cancer — [has] been widely used in melanoma, and it’s a big player in lung cancer. We were one of the first to develop this protocol and look at the safety of using it in treating patients with esophageal cancer.”

Throughout the month, the Esophageal Institute will be sharing stories and facts about the risks of esophageal cancer and its effects on the lives of patients and families. We'll also have some information about our innovative research and emerging technologies that can not only treat, but prevent, esophageal cancer.

Ask a Doc: Esophageal Cancer | Highmark Health Blog In our Ask a Doc series, we sit down with physicians and other clinical experts, including those at Allegheny Health Network (AHN), for a chat on an important health topic. In this interview, Dr. Blair Jobe discusses esophageal cancer.

It's Registered Dietitian / Nutritionists Day! Help us to recognize and applaud the efforts of our amazing dietitians, Ann and Rachel. The care and help they give our patients is truly immeasurable. Thank you, Ann and Rachel, for all you do!

Here’s another video on our channel about GERD symptoms, diagnosis, and treatment: https://www.youtube.com/watch?v=c-OpgQFcnxk

If you or someone you know has frequent heartburn, trouble swallowing, complaints of an acidic taste, or problems with chronic indigestion, we are offering FREE consultations with a provider. Take our free quiz to find out the risks for GERD: https://www.ahn.org/quiz/gerd.html Call 412.359.4373 or email [email protected] to request a call to talk about your risks.

We know many patients are worried about the rise of coronavirus cases in our area and across the country. We continue to take every possible precaution for everyone’s safety. We offer video visits for eligible patients, and we can schedule future appointments or collect information to contact interested patients to schedule an appointment once the risk factors diminish. Once established as a patient, much of our care can be provided without an in-person visit. If you are suffering, don’t wait for assessment! Take our quiz and talk to a provider today.

GERD Mentality This video from the Esophageal Institute at Allegheny Health Network discusses Gastroesophageal Reflux Disease (GERD), including its common causes, symptoms,...

Have you ever wondered what an EGD looks like to the surgeon? You’re in luck! Our own Dr. Yoshihiro Komatsu has a new video of a routine esophageal exam. You can watch it on our YouTube channel here: https://www.youtube.com/watch?v=5L4bojf7mps

Also, through November 27, we are offering FREE consultations with a provider to talk about your risk assessment and whether you should see our specialists now or in the future. Call 412.359.4373 or email [email protected] to request a call.

If you or someone you know has frequent heartburn, trouble swallowing, complaints of an acidic taste, or problems with chronic indigestion, try our free quiz to find out the risks for GERD: https://www.ahn.org/quiz/gerd.html

We know many patients are worried about the rise of coronavirus cases in our area and across the country. We continue to take every possible precaution for everyone’s safety. We also offer video visits for eligible patients, and we can schedule future appointments or collect information to contact interested patients to schedule an appointment once the risk factors diminish. Once established as a patient, much of our care can be provided without an in-person visit. If you are suffering, don’t wait for assessment! Take our quiz and talk to a provider today.

Walkthrough of a Routine EGD Dr. Yoshihiro Komatsu of the Esophageal Institute at AHN guides the viewer through a routine EGD. Dr. Komatsu demonstrates the process, discusses important s...

Have you ever wondered what an EGD looks like to the surgeon? You’re in luck! Our own Dr. Yoshihiro Komatsu has a new video of a routine esophageal exam. You can watch it on our YouTube channel here: https://www.youtube.com/watch?v=5L4bojf7mps

If you or someone you know has frequent heartburn, trouble swallowing, complaints of an acidic taste, or problems with chronic indigestion, try our free quiz to find out the risks for GERD: https://www.ahn.org/quiz/gerd.html

Also, this week and next (apart from Thursday November 26) we are offering FREE consultations with a provider to talk about your risk assessment and whether you should see our specialists now or in the future. Call 412.359.4373 or email [email protected] to request a call.

Walkthrough of a Routine EGD Dr. Yoshihiro Komatsu of the Esophageal Institute at AHN guides the viewer through a routine EGD. Dr. Komatsu demonstrates the process, discusses important s...

Have you ever wondered what an EGD looks like to the surgeon? You’re in luck! Our own Dr. Yoshihiro Komatsu has a new video of a routine esophageal exam. You can watch it on our YouTube channel here: https://www.youtube.com/watch?v=5L4bojf7mps

If you or someone you know has frequent heartburn, trouble swallowing, complaints of an acidic taste, or problems with chronic indigestion, try our free quiz to find out the risks for GERD: https://www.ahn.org/quiz/gerd.html

Also, this week and next (apart from Thursday November 26) we are offering FREE consultations with a provider to talk about your risk assessment and whether you should see our specialists now or in the future. Call 412.359.4373 or email [email protected] to request a call.

We know many patients are worried about the rise of coronavirus cases in our area and across the country. We continue to take every possible precaution for everyone’s safety. We offer video visits for eligible patients, and we can schedule future appointments or collect information to contact interested patients to schedule an appointment once the risk factors diminish. Once established as a patient, much of our care can be provided without an in-person visit. If you are suffering, don’t wait for assessment! Take our quiz and talk to a provider today.

Walkthrough of a Routine EGD Dr. Yoshihiro Komatsu of the Esophageal Institute at AHN guides the viewer through a routine EGD. Dr. Komatsu demonstrates the process, discusses important s...

It's National Gastroesophageal Reflux Disease Awareness Week!

Read about GERD in Pittsburgh Magazine here: https://www.pittsburghmagazine.com/the-important-differences-between-heartburn-and-gerd/

This article features Dr. Blair Jobe and one of our own employees, who is also a patient!

If you or someone you know has frequent heartburn, take our free quiz to find out the risks for GERD: https://www.ahn.org/quiz/gerd.html

And this week and next (apart from Thursday November 26) we are offering FREE consultations with a provider to talk about your risk assessment and whether you should see our specialists now or in the future. Call 412.359.4373 or email [email protected] to request a call.

We know many patients are worried about the rise of coronavirus cases in our area and across the country. We continue to take every possible precaution for everyone’s safety. We also offer video visits for eligible patients, and we can schedule future appointments or collect information to contact interested patients to schedule an appointment once the risk factors diminish. Once established as a patient, much of our care can be provided without an in-person visit. If you are suffering, don’t wait for assessment! Take our quiz and talk to a provider today.

The Important Differences Between Heartburn and Gerd | Pittsburgh Magazine It’s no coincidence that National GERD Awareness Week falls right before Thanksgiving.

November 17-23 is National GERD Awareness Week!

The Esophageal Institute has some exciting plans to mark the occasion. Did you happen to see our ad in Pittsburgh Magazine? If not, stay tuned – there’s a digital version coming!

Meanwhile, in preparation for GERD Awareness, Kirsten Newhams, MD, MPH, has recorded a short video about why GERD matters. Check it out here: https://youtu.be/IEbXe5pbltc

Over the next two weeks (with the exception of Thanksgiving Day), our providers will be offering a FREE phone consultation with anyone to discuss their heartburn or GERD-related symptoms and to determine if an in-person evaluation is a wise next step. We are also offering our online quiz to help patients assess their symptoms and risks for GERD. The quiz is available here: https://www.ahn.org/quiz/gerd.html

Take the quiz, learn about your risks, and call 412.359.4373 next week for a FREE consultation!

Why GERD matters Dr. Kirsten Newhams, one of the staff surgeons at the Esophageal Institute at Allegheny Health Network, discusses GERD (gastroesophageal reflux disease) as a...

The Esophageal Institute’s latest publication takes a step forward in the process to better define good candidates for magnetic sphincter augmentation (MSA) surgery. You can read the full article for free here: https://link.springer.com/article/10.1007%2Fs00464-020-08068-4

There are two surgical procedures typically offered to patients with gastroesophageal reflux disease (GERD). The first is a Nissen fundoplication, which uses part of the stomach to reinforce the lower esophageal sphincter (LES). The second is the placement of a magnetic augmentation device, or LINX device.

Our new study looked at patients who were one year out from MSA surgery, had good outcomes, and were free of significant postoperative dysphagia. When the patients underwent their one-year manometry exams, the staff measured the outflow resistance using intrabolus pressure (iBP) created by the LES. This measurement duplicates other studies that have been done with patients who underwent a Nissen, so the parameters can be compared to one another directly.

Each patient’s contraction amplitude was measured against their pre-operative test pressure. The figure below shows a sample, with before in the grey tracing line, and after in the black. Using this method, it was shown that the mean iBP amplitude increased from 13.3 mmHg to 19.2 mmHg. The upper limit of resistance was around 30 mmHg, which is about ten degrees higher than in previous studies of Nissen recipients.

This data supports previously held conjectures that implanting a LINX device creates more resistance at the esophagogastric junction during contraction than a Nissen. It implies that since a given force will be required to overcome that higher resistance, providers should incorporate this measurement into their consideration when selecting which procedure to offer their patients.

Dysphagia is one of the most common postoperative complaints, as well as one that is known to persist long after the procedure. Though there is a demonstrated chronology, in which the ability to overcome resistance increases over time, there is correlation between pre- and postoperative pressure, so it is also a factor in predicting outcomes. This study is a critical step to developing manometric criteria to optimize selection of MSA surgery candidates.

We’ve updated our YouTube channel with new videos!

In partnership with the Universidad Favaloro in Buenos Aires, Argentina, the Esophageal Institute has produced several informational videos about many of the conditions we treat and procedures we perform.

Here’s another video for you. This one’s about achalasia, which is a rare condition, but one that we can treat successfully using a procedure called a myotomy. Go here: https://www.youtube.com/watch?v=dvrDsTJ4TQM to learn all about it!

Closed-captioning is available.

Achalasia, My Dear - YouTube This short video explains the condition known as Achalasia and discusses treatment options.

Our staff at the Esophageal Institute are constantly pushing into new research territory. They’ve done it again, with a new publication!

A case report highlighting a rare esophageal disease, Esophagitis dissecans superficialis (EDS), is featured in the October edition of the Clinical Journal of Gastroenterology. The full article is available for free at this link:

https://link.springer.com/article/10.1007/s12328-020-01247-9

EDS is a rare, benign disease. It is characterized by white streaks, plaques, and/or stripes in the esophagus, or “sloughing” tissue, without any underlying mucosal abnormalities (see close-up photo). While the exact causes of EDS are unknown, it has been linked to the use of some medications, infections, medical conditions, and some behavioral factors. It can also occur spontaneously or idiopathically, without a clear cause. This has made the disease hard to study definitively. One of the theories in the literature involves a connection between esophageal strictures and EDS, leading to chronic esophageal retention. To date, there has been no description of EDS occurring in the face of esophagogastric junction outflow obstruction (EGJOO) without a stricture also being present.

The Esophageal Institute’s case review concerns a patient with dysphagia and long-standing gastroesophageal reflux disease (GERD) who subsequently and rapidly developed EDS and presented with a newly developed EGJOO.

Treatment of patients with EGJOO is dictated by the overall symptoms of the patient. In our patient, surgical relief of the resistance at EGJ resulted in relief of EGJOO and resolution of dysphagia. This also resolved the esophageal retention and led to resolution of EDS. In less than 1/3 of patients with EGJOO, there will be spontaneous improvement of symptoms without any intervention.

Both EDS and EGJOO are relatively rare conditions. This case presented us with a unique opportunity, as we were able to capture before and after changes that developed in the patient in the setting of confirmed EGJOO. While there is still much to investigate, this case offers another possible cause of EDS and points to some further theories about the conditions in which it can develop. Congratulations to the clinical research team!

(an earlier version of this post was missing an image)

The Esophageal Institute embarks on a new era in Erie! Shown from left to right: Andrew Grubic, DO, Scott H. Bedwell, MD, Blair A. Jobe, MD, FACS, Lee Hillman, and Xinxin “Sherry” Shen, PA-C, at the conclusion of our first Esophageal Clinic at Saint Vincent Hospital’s Hillside Office Building in Erie.

We look forward to working alongside Dr. Bedwell and other gastroenterology doctors in the Erie area. Drs. Jobe, Bedwell, and Grubic have plans to expand the Esophageal Institute’s multidisciplinary approach with endoscopy and surgery in the near future. Yesterday’s clinic was the culmination of over a year of planning and organization on the part of the Esophageal Institute administration. Many thanks to Dr. Bedwell, Kathy Scutella, NP, and her staff at the Saint Vincent Bariatric and Metabolic Institute, for their help to facilitate a fantastic start to this new venture.

To book appointments in Erie, please call 412.3595.GERD (412.359.4373), select Dr. Jobe, and ask for our Erie location.

And don’t miss Dr. Jobe’s LIVE Q&A on Facebook, in two weeks, on September 24! Submit questions ahead of time by comment or private message. We will also take questions during the Q&A. Add the event to your Facebook here: https://www.facebook.com/events/3514776781905701/

Esophageal Institute at AHN's cover photo

Today, we’re shining a light on our Administrative staff: Deb O, our West Penn Executive Secretary; Lee, our Project Coordinator; and Melissa, our Practice Manager.

The Esophageal Institute is a busy, complex practice, and Deb keeps track of all our needs. From ordering supplies, to taking minutes at our meetings, maintaining calendars, and processing payroll, Deb manages our administrative operations with a smile and a can-do attitude. If that weren’t enough, it seems she knows everyone at West Penn, and if she doesn’t, she can use her contacts to find whoever we need! Thanks, Deb, for your tireless efforts on our behalf.

Since joining the Esophageal Institute, Lee has taken charge of any number of ongoing and special projects. Lee coordinates our Fellowship Program, is in charge of credentials and privilege maintenance for all our providers, oversees our marketing efforts, and manages ongoing development and outreach related to our programs, especially our cancer patients. Lee is also the primary planner for educational meetings and events such as our annual Dallemagne Lecture in Surgical Innovation. (Notably, Lee is the voice behind these Facebook posts, so you can trust that everything we’re saying about her/him is 100% unexaggerated.)

Last but certainly not least, Melissa does a great job of keeping everything flowing. With the constant changes and the ever-evolving challenge of employee and patient safety in the era of COVID-19, Melissa has been working harder than ever – and her outstanding leadership has consistently kept our wheels greased and our gears grinding. She is always looking out for the best ways to respond to, and even sometimes to anticipate, the next steps to keep our patients and our employees safe. She makes sure everyone is staying focused and that we are keeping up with the demands of care as we navigate the new normal. Thanks so much, Melissa, for all you do!

Many patients experience spasms of their esophagus. This may feel like a sharp pain behind the breast bone. It can be caused by abnormal motility of the esophagus, GERD, or large amounts of food or fluid. Sometimes it can be the side effect of a procedure or surgery. Avoiding large amounts of food and fluid, cold liquids and food can help prevent spasms. Limit large meals and fluids.

If you experience a spasm, try to sit upright or stand up. Take slow deep breaths until the sensation passes. Avoid eating or drinking until the sensation passes.

If you have ongoing or worsening symptoms, please reach out to us at the AHN Esophageal Institute for further guidance and support: 412.359.GERD (4373).

Today, we are shining a light on our incomparable dietitians, Ann and Rachel. These two providers are integral to the success of every patient’s journey and we could not do what we do without them. Their guidance and counseling is crucial to improving outcomes, from providing dietary adjustment in the pre-operative period to enforcing proven habits after surgery. They are even able to help some of our patients just by making small changes to the foods they eat. Their expertise in diagnosing conditions such as Eosiniphilic Esophagitis (EOE), enzyme deficiencies, and small intestinal bacterial overgrowth (SIBO), among many other esophageal and gastric-related disorders, is instrumental in creating the most comprehensive treatment plan for our patients. They are particularly important during this time when it’s wise for patients with high-risk factors to stay home. Their counsel is keeping these patients safe and comfortable. Rachel and Ann, thank you for all you do!

Zenker’s diverticulum is an out-pouching of the esophagus located at the junction between the lower part of the throat and the top of the esophagus.

Typically, Zenker’s is diagnosed by EGD and barium swallow. It can be treated with a procedure called a diverticulotomy, a minimally-invasive procedure that can be performed endoscopically or surgically. In the endoscopic procedure, a special knife is used to cut through the division between the pouch and the esophagus to create one single path. The surgical option involves the surgical removal of the out-pouching portion of the esophagus via incisions in the neck.

Your surgeon will look at the size, shape, and other anatomical characteristics of the diverticulum as well as your pertinent medical history to determine which option is best for you.

If you have ongoing or worsening symptoms, please reach out to us at the AHN Esophageal Institute for further guidance and support: 412.359.GERD (4373).