[Music] treating abnormal tissue in the esophagus just got even more Hightech in this episode of being well I'll sit down with Sarah Bush Lincoln's Dr Jamon Patel who will explain how Barett esophagus is treated much more efficiently with the use of heat energy in a procedure called Halo oblation when sarush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the Ever Changing needs of our community has remained the same Horizon Health 50 years strong Carl is redefining Health Care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with health Lions is always at the Forefront to help you thrive [Music] thank you for joining us for another season of Wei TV is being well I'm your host Lacy Spence and today we are welcoming in a new guest to the show as we talk about all things esophageal and we are welcoming from Sarah Bush Lincoln we've got Dr Jamon Patel here today welcome to beingwell well thank you thanks for having me of course the pleasure is ours we love having new guests on the show and letting our viewers get to know them so can you please give us a little background who is Dr Patel sure so uh so my name is Jamon Patel um I am a gastroenterologist and uh I I practice basically in a specialty that involves GI gut health and that can Encompass anything you know uh involving your GI tract from your esophagus all the way down to the rectum um for this you know I've completed some training before um all of my training so far has been performed in Poria Illinois at the University of College of Med University of Illinois College of Medicine in Poria Illinois where I completed my Internal Medicine Residency and my GI Fellowship fair enough now we were talking a little bit before we got started you're not actually from the area right where' you come from so uh I I spent a lot of my adult life in San Francisco in the Bay Area um and so I was out there for my college Years and for several years after before going off to med school and um what brought me out here was that I fell in love with a woman from the Midwest who refused to give up the Midwest and so I chose to come here well wonderful and that is pretty correct that is right all right so we're also going to have pretty on later this season so that's going to be an absolute treat to to get the dynamic duo that you are well thank you uh today though we're talking about the esophagus so just to kind of lay the groundwork here um what would be five things off the top of your head that maybe impact um esophagus health and also your gastro health so uh in terms of of Foods or in terms of what things in specifics I would say what uh what are things that we can do to take care of ourselves what are maybe some downfalls that we fall into excellent questions so um just things to help improve our our I would say our gut health esophagus Health but even our Global Health there are certain bad habits unfortunately some people have which directly relate to pathologies of the esophagus some are smoking um or any kind of tobacco ingestion um alcohol is another sort of offender for these um and then as far as just day-to-day habits and excluding those things like delaying taking on a sapine or lying down position after eating so we should all actually be waiting about 2 to three hours um after eating before we lie down that way most of the contents from the stomach pass through into the small bowel and you minimize what contents can reflux up into the esophagus um beyond that it's also kind of listening to your body though a lot of foods can't harm you they can propagate reflux symptoms and actually promote gastro esophageal reflux so avoidance uh or minimizing things like caffeine um chocolate it's a lot of delicious things gosh yeah uh things that are rich in tomato onion garlic things like that so a lot of delicious things unfortunately isn't that how it always goes it is I also find it interesting you mentioned the staying upright because oftentimes people maybe if they overindulge a little bit the first thing they think ah I could use a nap true true um actually you just sparked a reminder for one other thing so actually overeating itself so um the way that our food is stored after we eat tends to be a little bit higher up and um what happens is if we overeat we stretch the stomach but your esophagus and your stomach are sort of contiguous and so when you do you tend to stretch the lower part of the esophagus as well and so the sphincter that's supposed to minimize reflux events gets propped open a little bit worsening reflux symptoms so it's a double whammy if you overeat and lie down oh my gosh as if we needed another you know reason but okay so this season we're also going to have an entire episode dedicated to gird um but just to kind of make sure our viewers are oriented to it as we have this discussion what is gird so gird is um it's a condition can have various different symptoms but it stands for gastroesophagal reflux disease okay and the basic concept is it is reflux of contents from our stomach um back up into our esophagus which is our food pipe and unfortunately that's really detrimental for various reasons um which I guess we're going to get into in a little bit but it can present in several different ways which I think is really important to know um some of the most classic symptoms are a sensation of burning up and down the chest then the other symptoms are something called water Brash where there's a sensation that liquids are actually coming up and sometimes often into our mouth we call that water Brash this can also lead to things like a kind of a persistent dry cough especially in the absence of any underlying lung disease having a constant dry cough could be a sign itself of gird um and then abdominal pain interestingly it can come in with right-sided abdominal pain smack dab in the middle called epigastric abdominal pain and then off to the left called left upper quadrant abdominal pain so a variety of different presentations and then the last one where it's happening um but no one knows that it's happening is called silent reflux and that's kind of a scary one because it's going on in the background all the time it can have dilus effects and uh it's often not diagnosed until really late for often for some other reason because the patient never feels the symptoms of gird what's happening with that when you can't feel it so unfortunately that's where a a lot of risk for things like barretts esophagus occur um and unfortunately the way it can present other ways so that you know that's one of the I would say the more severe kind of outcomes the other potentials are someone will be seen because all of a sudden they can't swallow very well and what's happened is their esophagus is actually narrowed and tapered down some into a stricture um and so they're having trouble swallowing and it was because of reflux that was occurring for this long period of time but they never sensed it they never knew it gosh yeah okay so that's that's scary um that is to take a step back when you talk about the burning is that just like heartburn or something different that's exactly right so the other term for that what we call substernal burning which is up and down the chest um that is what we would classically call heartburn so heartburn is a synonymous term for gird it's one of the manifestations of gird okay and then um the other condition that you had talked about about um I feel like I've heard the the layman's term of like a wet burp is that yeah kind of sim you're right yeah yeah so um that that sort of is now if it's a very sporadic here and there then yeah that's perfectly okay but if it's something that a patient is experiencing frequently um that's probably worthwhile to get investigated a little further because it shouldn't really be that frequent in fact so the base of our that I was referring to earlier there's a little sphincter there and that sphincter is supposed to open um multiple times per day that's physiologic it's normal and it's supposed to for venting purposes when we eat if we consume carbonated beverages um we need a way to release some of that trapped air and gas so we Bouch and we let that out but it shouldn't really it should be dry it it shouldn't come with fluids if it does you are regurgitating some of that content that's what's happening MH okay so you mentioned esophagus and that's part of what we'd like to discuss today um can you kind of dive into it what is it what does it look like and so on absolutely so Barett esophagus is uh it's the culmination of a long-standing history often of gird of gastro esophageal reflux disease and in it what happens is that the lining of our esophagus starts to change to resemble the lining of the stomach so we have different kinds of cells that line different parts of our GI tract because those cells carry on different functions though the cells that line the stomach are actually meant to accommodate um stomach acid which is rather acidic our esophagus is not meant for that in fact the sphincter again mostly closed so this should not really be exposed to acid frequently but over time if there's long-standing reflux that acid keeps washing up and down into the esophagus and to better accommodate and handle that acid the esophagus is lining changes to match that of the stomach that's crazy it's wild so it's doing it in a way as this response to sort of help you but unfortunately sometimes the body's good nature to try to help us can lead to some Aber baranes down the line and some changes because it wasn't designed it wasn't meant to do that and so the lining of the esophagus changes from what's called squis which is the normal esophagus uh lining into something that's called columnar which is literally kind of like cubes or columns um which is a thicker kind of lining for the stomach but in doing so then these precancerous changes start to happen and they go from slightly precancerous which is what we would call low-grade dysplasia to higher grade which we would call high-grade dysplasia then the next step is adenocarcinoma in C2 so there's cancer overtly there and then the next step is uh metastatic adenocarcinoma which means it is now disseminated and spread through the body so the goal is to capture it long long long before then absolutely um are there risk factors as far as just me as a person am I more susceptible to it as a woman a man young old great question so uh you actually so you and all um female gender have a much lower likelihood of developing bars esophagus all right this is one of those yeah this is one of those conditions where I would say men have it a little bit worse here um unlike things like autoimmune conditions those tend to be more predominant in the female population so some of the risk factors for gird do include just being a man you actually get a point for that there's like a a point scoring scale that is used to determine if someone should or shouldn't uh undergo not shouldn't but should undergo an upper endoscopy for screening yeah one of those is being a male um the second is a a and this is one of the most important naturally but it's a long-standing history of gird at least 5 years so if someone's had reflux for 5 years even if it has been well controlled that's like the basic point for the rest of the screening then it's men age over 50 m um it is any smoking history it includes being overweight or uh obesity falls under that category then certainly other factors include things like a family history of barit esophagus or esophageal cancer in general all of these are factors that we take into account and if someone meets two out of the criteria including the most important one which is you have Gir um you should undergo a screening exam with an upper endoscopy and so you've done your investigation you've discovered that someone has this condition what's next how do we fix it great question so the the beautiful thing about this is that most people don't necessarily have to have it fixed okay um those different categories that I was discussing where there's lowgrade dysplasia um high-grade dysplasia and you know adenocarcinoma in C2 followed by the metastatic the disseminated or spread cancer there is this prior entity that is called nondysplastic that means it's precancerous but the tissue is still organized enough that it hasn't begun any concerning changes and if there is something nice to say about barit esophagus it's that it is a slow moving creature so the risk of progression is really low in fact it it's on the order of 0.7% annually um if there's no dysplasia and those percentiles increase if you have low grade plasia now you're you're in at least in the single digits for it progressing annually and if it's high-grade displasia you're in the double digits so most people who get diagnosed with barretts will be diagnosed as a nondysplastic barretts so they they don't have any signs of the cancer already there if that is the case then those patients just need to undergo routine surveillance exams with an upper endoscopy and for what it's worth upper endoscopy is quite easy because there is no bowel prep it is not like a colonos y um they don't have to do clear liquids for a whole day and drink all that stuff and and then you know prepare um it's a the day before the exam is a normal day you go about your business at midnight you stop taking anything in by mouth and you get your exam done but the point was that once you have it if it's non- dysplastic one year out from that first exam where we diagnosed you we check it again we biopsy it again we make sure everything is stable if it is wonderful space out to three years and it's every 3 years thereafter um in the meantime there is something we can do if you're diagnosed with barretts to help minimize that risk of progression and in a really small subset actually have it regress go away um that is the use of acid suppressors how we would treat gird in the first place you treat the underlying cause so using proton pump inhibitors um are one of the Main Stays of therapy currently and controlling acid reflux symptoms for patients who actually feel the symptoms much trickier in the silent gird patients but for those who feel symptoms controlling it so that their symptoms are resolved is one of the ways we help keep this at bayh and so as we're moving toward the more severe cases um if we have to do more drastic measures um on my list here I have Halo oblation I'm not sure if that's the same thing as EGD oblation uh yeah so sort of you could say sort of synonymous but what is this sort of treatment what is this look like what is it great question so it's still it's using a standard upper uh endoscope what we call a gastroscope but essentially we have different tools that we can use in conjunction with the scope so once we finish our exam looking in the esophagus the stomach uh the small intestine then we focus our attention to the barretts tissue and we do so um by using these catheters or balloons depending upon how much of the esophagus is affecting by the Barrett's tissue okay so using these tools we basically have these devices that allow us to apply direct thermal pressure contact pressure to the areas of the esophagus that are affected and we burn that tissue to put it as simply as I can it's called a radio frequency ablation and it allows us to treat that area rather uniformly with sort of a uniform depth and spread around and we ablate we burn any infected area of barit esophagus usually there are a couple of sessions but um that is the treatment so it's it's done endoscopically so the EGD ablation aspect that you were mentioning um and so Halo ablation or radio frequency ablation is what we what we do now those are reserved for patients once we have dysplasia okay so a patient who has barretts but it's the nonis plastic kind they do not need to undergo therapy for that they just need to have it surveilled and and if you're one of the many where it will never work its way over towards cancer wonderful you never had to undergo that therapy but if it ever does the beauty of doing it every 3 years especially with it like I said being a slow moving creature right um that we can capture it and then we can start to oblate that tissue and get it gone okay so with burning recovery time does it hurt great questions the first session I would say most patients do experience some discomfort some pain um it's not common that it's any severe pain but that's not out of the question it also depends on how much of the esophagus is involved the greater the extent of involvement the more therapy we're applying to the esophagus and so the greater the risk that there can be pain um but generally no I would say most patients actually come out of it feeling quite well and with each subsequent session because usually at least several are needed um after their first one they they report back that they're actually doing quite well in recovery sometimes they'll joke back and go did you actually do anything this time so it works well well that has to be a good feeling it does sit them on their way smile on their face feeling much better that's right um before we pivot topics is there anything else about that in particular that I didn't quite ask about that needs covered uh no I mean I think you covered it really well I don't think uh I have anything else to contribute to that okay so moving on down this is system um not necessarily a glamorous topic um but hemorrhoids people get them um can you kind of talk about the risk factors for that or you know things that make it better or worse absolutely so um you know for to kind of just explain what hemorrhoids are to start with hemorrhoids they are just um they're sort of plexuses of veins and just like varicose veins these are just veins that become engorged and they don't empty out well again which is what leaves them sort of gorged and swollen um risk factors for them are anything that can promote blood flow to those areas and sort of trap it in those areas so some of the you know coming back to the what kind of habits do we have you know that can worsen things so there are some habits that can worsen hemorrhoids so one of them is actually being sedentary so sitting a lot is one of them um so unfortunately some careers do involve that like truck drivers or anybody that uh probably airline pilots who are flying for a long time time anytime that you're just prolonged sitting increases that risk um other things though are things like constipation and irregularity with our bow habits because often times to facilitate that patients will strain or they'll you know have to apply abdominal and pelvic pressure in order to have a bowel movement and that pressure itself can cause engorgement of those veins and they can kind of stay that way then the third habit I think is probably one that's more of a problem now than it used to be let's say 10 years ago um is prolonged sitting on the toilet I think uh one of the things that that patients tend to do a lot now is that sometimes they'll feel the need to have a bowel movement go to the toilet um sit down on the phone now or reading something or responding to messages and you're kind of losing track of what you're doing and that time is sort of getting wasted and you're just sitting there remember the toilet seat is like a donut so there's an area where everything is just sort of drooping uh if if you see I'm saying and so losing track of time there is probably not a great idea because then we're just promoting blood flow to that area again so it should be you go potty when you need to go potty when you're done get up and go about your business be a little more intentional go a long way go exactly um what about as far as uh pregnancy in our last couple minutes here excellent question excellent so so pregnancy certainly increases the risk of developing hemorrhoids as well and that's because for you know for several factors one of which are the hormonal changes that occur in pregnancy they tend to promote constipation um and so therefore more straining harder stools things like that but then the second one is actually direct pressure from the fetus in the in the abdomen and the pelvis so that pressure alone can actually also promote constipation so constipation is one of the frequent things that um women encounter during pregnancy and it's for those reasons anything that worsens constipation can worsen the hemorrhoidal issue so most women who have given birth have some hemorrhoids mhm um I know pregnancy is not an across theboard thing but um for people who are struggling with constipation are there any easy ways to correct that there are uh that's a wonderful question and that's because I think most of the time most of our constipation actually tends to fall under some inadequacies inadequate water intake and inadequate fiber intake are two of the main problems that um that we see actually and so most patients don't have a significant constipation that requires medications or drugs the overwhelming majority of patients will actually improve by increasing their water intake to a known consistent metric and um an increasing fiber consumption whether through hopefully better eating habits more fruits more vegetables but if need be the consumption of something like a fiber supplement and so as we're wrapping up here are there any cases that you've dealt with that come to mind any success stories as far as pretty much changing someone's life radically from dealing with um you know going back to the esophageal issues um having really bad maybe acid reflux or you know something that's really impacted their quality of life uh I would say Yes actually more than one to be honest with you um I think that's one of the things that I love about my job is that I get to see relatively quick turnarounds and improvements in patients through either direct interventions or making some immediate changes um but I I think a lot of the satisfaction I get is from treating some of the more scary more severe disorders and so some of my favorites actually deal with eradicating barit esophagus when they're already down that precancerous pathway when it used to be you know surgery was necessary to treat that and it would come with a very high risk for debility afterwards or risk of dying um and now treating it endoscopically and then the patient sort of in disbelief that it's like wait it's gone you show them the photos of the before and the after and they just can't believe it and outpatient I mean that has just come such a long way that we okay we'll send you on your way you get a recover at home that makes such a a big difference um before we wrap up here if I'm somebody who is in need of seeking a specialist uh can I seek you out first or do I need to go through my primary care doctor great question um I think most people have to go through their Primary Care physici they need to undergo or they need to have a referral now my particular um job currently is that I do inpatient Hospital coverage so the Rel ly sick patients who are admitted to the hospital for most of my time or or I should say 50% of my time the other 50% I don't do clinic so I wouldn't uh be able to see a patient in an office setting but I do outpatient endoscopy so oftentimes Primary Care docs will refer a patient to me um for the need for let's say an upper endoscopy for someone who's been battling their reflux symptoms or somebody who's going to get an upper or lower endoscopy because of bleeding issues so they can be direct referred into that um but we do have other people who are in our office that uh patients can see either before or after um but most of the time we're able to address things right there at the time of endoscopy or through some Simple Communications thereafter well I can vouch I have a loved one who went in for one recently 10 minutes I typed it it was it was wild watched them wheeled away wheel back 10 minutes flat so it's it's amazing what you all can do well thank you it is an efficient process well Dr Jam Patel thank you so much for coming on being well we've learned so much today well thank you thank you again for having me of course the pleasure is ours and thank you to our viewers for joining us for this episode of being well and I hope to see you next time Carl is redefining healthc care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Carl with Health Alliance is always at the Forefront to help you thrive for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to meet the everchanging needs of our community has remained the same Horizon Health 50 years strong when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's healthcare needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care [Music]