Swallowing and Heartburn Center

About This Program

We are a leading referral center in New England for the treatment of achalasia, a common swallowing problem, and provide treatment and ongoing care for the full range of gastroesophageal and swallowing conditions, including:

• Achalasia
• Barrett’s esophagus
• Chronic abdominal pain
• Chronic cough
• Chronic heartburn
• Dysphagia
• Esophageal cancer
• Esophageal motility disorders
• Chronic GERD (gastroesophageal reflux disease) that has not responded to oral medication such as proton pump inhibitors
• Laryngo-pharyngeal reflux disease (LPR)
• Noncardiac chest pain
• Premalignant esophageal lesions
• Postsurgical esophageal symptoms

Advanced Diagnostic Motility Evaluation Services

The Digestive Healthcare Center is the one of few centers in the Eastern United States currently offering gastroduodenal manometry and Smartpill technology, which detects conditions related to nonfunctioning stomach muscles, including gastroparesis and GI motility disorders of the small bowel and colon.

 We offer inpatients a quick turnaround and highly specialized, expert analysis of their test findings, 24 hours a day, for a range of diagnostic and therapeutic procedures. Our endoscopists are available around the clock to confer with referring physicians. Diagnostic services include:

• Endoscopic ultrasound, which creates an image of the esophagus using sound waves
• High-resolution manometry, which measures pressure within the gastrointestinal tract using special sensors
• Esophageal motility test, which measures the esophagus’s ability to move
• pH probe testing, used to diagnose gastroesophageal reflux
• Wireless Bravo pH testing
• Impedance/pH testing to determine if stomach contents are coming up into the esophagus

Our diagnostic radiology team comprises dedicated imaging specialists whose practice focuses specifically on GI scans. They are nationally recognized for expertise in all forms of sophisticated imaging and offer a full range of advanced diagnostic techniques, including:

• Fiber optic evaluations, which measures a patient’s ability to swallow
• Video-fluoroscopic swallowing studies, which captures video X-rays after the patient has taken barium
• Barium esophagrams, which captures images after the patient has taken barium, an element that helps with X-ray imaging
• Speech pathology assessments to identifies speech and language deficits

Referring physicians can request these diagnostic studies by contacting the Swallowing and Heartburn Center’s access coordinator.

Our Approach

The Swallowing and Heartburn Center brings together a team of gastroesophageal specialists who provide expert diagnosis, cutting-edge medical and surgical interventions and ongoing care for throat, esophagus and stomach disorders.

Coordinated Care for Gastroesophageal Disorders

Our board-certified digestive health specialists work together to help patients diminish episodes of discomfort through diagnosis and treatment options, including a combination of medication, lifestyle changes, endoscopic therapies and, when appropriate, surgical procedures.

The Swallowing and Heartburn Center works collaboratively with surgeons in Massachusetts General Hospital’s Gastroesophageal Surgery Program to provide comprehensive, personalized treatment for patients with gastroesophageal conditions. Our surgeons specialize in complex surgical techniques, such as magnetic sphincter augmentation (LINX procedure) for the treatment of gastroesophageal reflux disease (GERD) and endoscopic myotomy (POEM procedure) for the treatment of achalasia. Learn more about gastrointestinal surgery.

Leaders in the Medical Management of GI Motility Disorders and Surgical Treatment of GERD and Hiatal Hernias

We are a leading resource for patients who have had previously unsuccessful antireflux operations.

We are also a leading center for the development of new therapeutic approaches, such as natural orifice transluminal endoscopic surgery (NOTES), in which surgery is performed without the need for incisions.

We specialize in the surgical treatment of GERD (gastroesophageal reflux disease) and hiatal hernias.

As high-volume surgeons, we have achieved excellent results in repairing hiatal hernias and relieving patients of GERD symptoms. Nearly 75% of patients undergoing surgery can discontinue acid suppressive medications and more than 90% of patients undergoing surgery at Mass General expressed a high degree of satisfaction with their outcomes. [Source: D.W. Gee et al. (2008). Measuring the Effectiveness of Laparoscopic Nissen Fundoplication: Long Term Results. Archives of Surgery 43, 482–487.]

Other surgical interventions include:

• Esophagectomy, surgical removal of the esophagus
• Gastrectomy, surgical removal of the stomach in patients with stomach cancer
• D 2 node dissection, a more complete surgical sample of the lymph nodes used to ensure thorough diagnosis of gastric cancer
• Transoral Incisionless Fundoplication (TIF), minimally invasive procedure with no incisions in the abdomen to treat GERD

Laparoscopic Procedures and Other Minimally Invasive Options

Minimally invasive treatments are often options for patients who would have required traditional open surgery in the past. These new techniques have the benefit of faster recovery times, smaller surgical scars and greater nerve preservation. Minimally invasive options include:

• Laparoscopic antireflux surgery: We were one of the first hospitals in New England to perform this procedure and continue to be a leading source today
• Laparoscopic heller myotomies: We have performed some of the highest volumes of this procedure in New England to treat achalasia
• Laparoscopic procedures to treat cancers of the esophagus, stomach and gastroesophageal junction: We are one of the few hospitals in the world to offer these minimally invasive procedures

Minimally Invasive Ablation Procedures

Surgery may not be an option for all patients or conditions. For those patients for whom surgery is not possible, minimally invasive ablation procedures include:

• Radiofrequency ablation, a novel method offered by few centers in New England, used to treat Barrett’s esophagus
• Photodynamic therapy, a laser procedure used on precancerous areas or to destroy lesions caused by Barrett’s esophagus
• Endoscopic mucosal resection, an endoscopic means of removing small cancers from the stomach and esophagus that does not require surgery 

Clinical Research Studies and Trials

Our physicians are active in clinical trials and research studies related to gastroesophageal and swallowing disorders, allowing us to bring our patients promising new treatments as quickly as possible.

Our surgeons have helped evaluate first generation endoluminal therapies, such as the NDO Plicator and the Bard EndoCinch Suturing System, involving minimally invasive surgeries performed through the esophagus. We are currently evaluating newer developments in this area such as the Esophyx Totally Intraluminal Fundoplication.

We also published a landmark study demonstrating that not all patients with paraesophageal hernias would benefit from surgery. [Source: N. Stylopoulos et al. (2002). Paraesophageal Hernias: Operation or Observation. Annals of Surgery 236, 492–501.]

Current pioneering research efforts include:

• A Medigus trial to study the safety and effectiveness of the Medigus SRS Endoscopic Stapling System in gastroesophageal reflux disease (GERD)
• Clinical trials of less invasive treatments for gastroesophageal reflux
• Clinical trials related to the neoadjuvant treatment of gastric and esophageal cancers through the Cancer Center
• The use of natural orifice surgery to remove diseased organs without making incisions in the body wall
• The treatment of gastrointestinal stromal tumors (GIST) by combined endoscopic and laparoscopic methods