For most people, swallowing is an easy reflex requiring no special effort. But for others, swallowing may be a difficult and painful task. Swallowing disorders not only affect an individual's physical health, but can cause social, emotional and financial problems as well.

A Multidisciplinary Approach

The USC University Hospital Swallowing Program as established to assist individuals suffering from swallowing and esophageal problems. Because swallowing is a complex process, the Swallowing Program utilizes a multidisciplinary approach, bringing together the individual talents of the Keck School of Medicine of the University of Southern California physicians, including:

• Gastroenterologists
• Neurologists
• Surgeons
• Otolaryngologists (ear/nose/throat)
• Pulmonary specialists
• Pathologists
• Speech pathologists
• Rehabilitation experts
• Radiologists
• Thoracic specialists
• General physicians
• Psychiatrists

Together, these specialists review extensive diagnostic evaluations, exchange observations, and determine an appropriate method of treatment to help alleviate the individual's problem.

Symptoms Associated with Swallowing Problems

Symptoms are often subtle and many individuals subconsciously compensate for swallowing disorders by preparing foods that are easy to eat, eating slowly, using different sets of swallowing muscles, or changing head position as they swallow. Problems that commonly bring patients to the Swallowing Program include:

• Repeated episodes of heartburn
• Slowness or difficulty eating
• Coughing or choking on food
• Food sticking in the throat
• Chest pain
• Chronic cough
• Lump in the throat
• Shortness of breath
• Pain with swallowing
• Frequent cases of pneumonia

Common Causes of Swallowing Problems

There are many disorders that can cause swallowing problems. They include:

• Gastrointestinal disorders
• Benign tumors
• Cancer
• Head or neck injuries
• Neuromuscular disease
• Neurological disease
• Birth defects

Other advanced techniques specifically designed to pinpoint swallowing problems may be ordered if needed. In a group conference, the Swallowing Program team exchanges observations, determines a diagnosis and recommends an approach to treatment. Throughout the process, each patient receives highly individualized care.

The Program's staff works closely with the patient's own physician, monitoring improvement and determining if any changes in treatment are needed.

Advanced Evaluation Techniques

Evaluations available through the USC University Hospital Swallowing Program include:

• Video Esophagram: An x-ray video technique that examines swallowing actions of the pharynx, mouth and esophagus.
• Esophageal Manometry: A diagnostic test which measures and records the muscle function of the esophagus.
• Endoscopy of Pharynx, Esophagus and Stomach: An examination technique that allows the physician to visualize the interior of the swallowing apparatus.
• 24-hour pH Monitoring: A test to determine how often the esophagus is exposed to gastric juice.
• Quantitative Radionuclide Gastric and Esophageal Scanning: An examination to determine how effectively the esophagus or stomach empties swallowed food.

Expertise in Gastroesophageal Reflux Disease

Physicians in the Swallowing Program have been specifically trained, through research and extensive experience, to diagnose and treat gastroesophageal reflux disease (GERD). While antacids may provide temporary relief for patients who have frequent heartburn, new medical techniques that help provide lasting relief may be available for people with serious, chronic heartburn, or GERD.

When patients who suffer from GERD eat, food passes down the esophagus into the stomach. Under normal circumstances, the valve between the stomach and the esophagus prevents food or acid from moving back upward. But people whose valve muscles are weak experience problems with regurgitation. This causes a burning sensation in the chest. Besides being painful, this condition can damage the esophagus, causing ulcers, respiratory problems and a pre-cancerous condition known as Barrett's esophagus.

Medication and lifestyle changes may be enough to ease reflux symptoms. However, for more severe cases, surgery may correct the problem.

• Minimally Invasive Surgical Approaches In the past, an open surgical procedure was necessary to surgically stop gastroesophageal reflux in patients with severe disease. Today this can be done by using laparoscopes. Some of the work in laparoscopic Nissen fundoplication was pioneered at USC University Hospital. The procedure takes approximately two hours and patients may return home a few days following the operation.

• Customized Options for Surgery USC University Hospital takes a customized approach to antireflux surgery. While some patients with severe reflux disease may benefit from the laparoscopic Nissen fundoplication, a transthoracic Nissen may be more appropriate in patients with normal function and questionable esophageal length or obesity.

  To determine which surgical approach may be appropriate, USC University Hospital depends upon the expertise of the Esophageal Function Laboratory located adjacent to USC University Hospital.

For More Information

For a physician referral, please call 1-888-700-5700.