In reflux disease (for example, GERD), the bottom of the esophagus is too loose and allows too much food and fluid to reflux into the esophagus causing heartburn, regurgitation, damage, ulcers and even precancerous changes in the esophagus. An ARMS procedure removes the mucosa at the junction between the bottom of the esophagus and top of the stomach. Patients may return to work the day after the procedure.

The esophagus is a complex organ that requires specialized tests. The 24-hour pH impedance tests to see if the patient has reflux disease (GERD). This involves a flexible and small catheter inserted into your nose to reach the stomach. The 48-hour Bravo pH testing involves endoscopically placing a capsule into the lower esophagus to measure if reflux and the degree of acidity.

Patients with difficulty or pain swallowing or chest pain not related to the heart be referred for a “motility study.” Esophageal manometry is a test that allows us to measure how the patient’s esophagus is contracting, how much, and how often. Patients must be awake for this procedure.

EndoFLIP is a new technique that measures the area across the lower esophagus and the pressure inside of it. The ratio is measured and called distensibility (or stiffness). During an upper endoscopy, the patient is sedated and the endoscopist will place the catheter across the lower esophagus and into the stomach. The balloon is inflated with water and pressure measurements are taken. The procedure is typically 10-15 minutes long. This is a great alternative when patients need an esophageal manometry test but cannot tolerate it or decline to do it from discomfort.