Blog

Growing Acceptance of the EsophyX Antireflux Procedure

nospam@example.com (Dr. Starpoli) — Fri, 13 Nov 2009 15:27:13 -0800

The American Society of General Surgeons and the Society of American Gastrointestinal Endoscopic Surgeons have accepted the EsophyX Procedure, a transoral (through-the-mouth) incisionless fundoplication (TIF) for the treatment of gastroesophageal reflux disease (GERD).

Unlike previous endoscopic therapies for reflux such as EndoCinch or Plicator, the EsophyX TIF procedure provides a remodeling of the gastroesophageal "flap" valve thereby improving the antireflux barrier.

More and more patients have turned to this truly minimally invasive surgery as an alternative to daily medical therapy with acid reflux reducing drugs.

Esophyx has been developed by EndoGastric Solutions and is performed by Dr. Starpoli.

Reflux Monitoring Testing

nospam@example.com (Dr. Starpoli) — Sun, 07 Jun 2009 18:27:27 -0700

The current state-of-the-art method for assessing gastroesophageal reflux (a.k.a. GERD) continues to be impedance combined pH monitoring. While this does involve having a very fine sized tube placed into the nose and then into the esophagus, it offers the ability to find not only acid reflux, but nonacid reflux.

Nonacid reflux accounts for about 40% of reflux not completely controlled by the usual acid lowering drugs; the most popular of which are the proton pump inhibitors. More and more, we are realizing that the mechanical aspect of reflux related to dysfunction of the lower esophageal sphincter (LES) may be a better target for therapy when compared to acid control alone. Drugs that will act on the LES function are on the horizon. Additionally, the evolution of incisionless reflux surgery progresses.

Diverticulosis and Diet

nospam@example.com (Dr. Starpoli) — Tue, 02 Sep 2008 10:18:28 -0700

Nuts, Seeds, Popcorn Don't Boost Diverticulosis Risk

Study disputes conventional wisdom, but other experts say those foods cause pain for some

Posted August 26, 2008

By Kathleen Doheny
HealthDay Reporter

TUESDAY, Aug. 26 (HealthDay News) -- People with diverticular disease, a common digestive disorder, are typically told to avoid eating popcorn, nuts, seeds and corn so they don't get painful attacks.

But a new study calls into question that conventional wisdom. The study of more than 47,000 men found that eating those foods did not seem to increase the risk of diverticulosis or diverticular complications.

"We found, contrary to current recommendations, that actually, consumption of these foods did not increase the risk of diverticulitis or diverticular bleeding and didn't appear to increase the risk of developing diverticulosis or its complications," said study lead author Dr. Lisa Strate, an assistant professor of medicine at the University of Washington School of Medicine, in Seattle.

The findings are published in the Aug. 27 issue of the Journal of the American Medical Association.

Diverticular disease affects the colon, the part of the large intestine that discards waste. Diverticulosis occurs when pouches -- called diverticula -- form in the colon. Stool or bacteria can lodge in the pouches. Diverticulitis occurs when the pouches get inflamed; symptoms can include bleeding, infection or a blockage of the digestive system.

One third of U.S. adults have diverticulosis by age 60, although most do not experience serious problems. By age 85, two-thirds of people have come down with the condition, according to the U.S. National Institutes of Health.

The exact cause isn't known, although many experts blame a low-fiber diet. Muscle strain during defecation may cause the pouches to form.

The advice to avoid nuts, seeds, popcorn and corn comes from the belief that these foods may be more likely to become lodged within the pouches. But there's been no proof demonstrating such a link.

And Strate's study failed to find a link, either. Evaluating data from the long-running Health Professionals Follow-up Study, a cohort of men followed from 1986 to 2004, she and her colleagues looked at medical records every two years and dietary information for every four years. The men ranged in age from 40 to 75.

At the study start, all were free of diverticulosis or complications. Eighteen years later, 801 had experienced diverticulitis, and 383 had diverticular bleeding.

When the study authors compared men with the highest intake of foods such as nuts with those with the lowest, they found that those who ate the most nuts were actually 20 percent less likely to get diverticulitis than those who ate the least. And those men who ate the most popcorn were 28 percent less likely to get diverticulitis than those eating the least.

No association was found for corn.

Strate thinks the longstanding dietary recommendations should be reconsidered, but she cautioned that hers was just one study. She believes the findings would probably apply to women, too.

Dr. Anthony Starpoli, an attending gastroenterologist at Lenox Hill Hospital in New York City, who is familiar with the new findings, said that even though the study numbers were large, the results may not apply to everyone. "There are probably going to be a subset of people where perhaps a more restrictive diet does benefit them," he said.

Starpoli said that, while the recommendation to avoid nuts, popcorn and seeds isn't based on scientific studies, there are people who do experience distress when they eat those foods.

"If you are a patient with known diverticular disease, and you have had the experience of eating seeds, nuts and popcorn and developed diverticular pain as assessed by your doctor, you should probably not have those foods."

More information

To learn more about diverticular disease, visit U.S. National Digestive Diseases Information Clearinghouse.

EsophyX: Incisionless Antireflux Surgery

nospam@example.com (Dr. Starpoli) — Sat, 28 Jun 2008 06:56:32 -0700

I am pleased to announce the arrival of the Endogastric Solutions EsophyX transoral (through the mouth) antireflux surgical procedure. While this is an endoscopic assisted procedure it is an incisionless, surgical procedure that most mimics a formal surgical Nissen fundoplication. The difference is that this is a Transoral Incisionless Fundoplication (a.k.a. TIF). There is no cutting! The results are encouraging from the data available with the majority of patients symptom free and off of medications that control acid production. Other endoscopic approaches have not been able to reproduce the almost circumferential augmentation of the antireflux barrier and valve at the end of the esophagus or food tube. I am very excited about this new surgical procedure that will be performed by the advanced gastrointestinal endoscopist and look forward to our own results.

The "Passing On" of the NDO Plicator

nospam@example.com (Dr. Starpoli) — Sat, 28 Jun 2008 06:41:39 -0700

As many of reflux sufferers know by now, the NDO Surgical group was acquired by another medical device company. After several years of success with the Plicator in the arena of true incisionless antireflux surgery, the Plicator system as of May of 2008 is no longer available. To be clear, the removal of Plicator was not because of any fault of the device. In fact, the application of multiple plications with Plicator was demonstrating better clinical success than a single plication. The decision to withdraw the product was most likely due to the poor insurance carrier coverage for this type of procedure that has prevented other advanced gastrointestinal endoscopist from adopting the technique. Therefore, driving sales of the product was impaired. Until the dust settles with regard to the battle for insurance coverage for these procedures, this will be a recurrent problem for all newer technologies and techniques.

Helicobacter pylori Resistance and Therapy

nospam@example.com (Dr. Starpoli) — Tue, 07 Aug 2007 07:35:49 -0700

It is becoming very clear that the nasty little bug called Helicobacter pylori (a.k.a. H. pylori) has a growing level of resistance to the usual drugs used in treating this infection. There is a new concept of sequential drug therapy that appears effectively combat one of the mechanisms of resistance that are employed by this bacterium.

H. pylori is associated with gastric cancer and generally should be treated. The infection causes chronic active gastritis that can cause abdominal pain and bloating. It is a very common cause of peptic ulcer disease.

The infection is often diagnosed by biopsy of the stomach, breath testing and a simple stool test. Blood testing for H. pylori is not very reliable.

Should you have concerns about this disease, see your doctor.

Impedance Testing for GERD

nospam@example.com (Dr. Starpoli) — Sat, 24 Jun 2006 18:14:00 -0700

The use of the Sandhill Scientific combined pH-impedance reflux monitoring system continues to provide a more complete picture by allowing the assessment of acid and nonacid reflux. It has become especially helpful in cases of atypical reflux and in those patients that are poorly responsive to medical therapy.

Nonacid Reflux: A New Reality

nospam@example.com (Dr. Starpoli) — Sat, 17 Jun 2006 18:13:00 -0700

With newer methods, namely impedance reflux monitoring, we can diagnosis reflux as acid or nonacid. In populations failing to respond to acid suppression medical therapy, 40 % or more patients have nonacid reflux. The nonacid reflux may account for persistent symptoms while on medical treatment.

Irritable Bowel Syndrome & Bacterial Overgrowth

nospam@example.com (Dr. Starpoli) — Wed, 14 Jun 2006 18:14:00 -0700

Recent reports suggest a role of small intestinal bacterial overgrowth (SIBO) as a causative factor in irritable bowel syndrome. SIBO can be easily tested by noninvasive hydrogen and methane breath testing. Ask your doctor about breath testing for bacterial overgrowth testing and be sure that the test includes both hydrogen and methane measurements. Dr. Starpoli offers such testing should the need arise.

Diet and GERD

nospam@example.com (Dr. Starpoli) — Wed, 14 Jun 2006 18:11:00 -0700

If you have acid reflux and you drink coffee, consider stopping this habit. The trick is to stop all coffee including decaffeinated coffee. An improvement should be noticed in a week or so.

nospam@example.com (Dr. Starpoli) — Wed, 01 Mar 2006 18:14:00 -0800

If you have a family history of colon cancer or are age 50 or older, please see your doctor and discuss colon cancer screening tests. One of many helpful web sites that explore the issues surrounding colon cancer prevention and screening is www.screen4coloncancer.org.