The Bravo pH Capsule - slightly larger than the top of a number two pencil.

It is estimated that more than 60 million Americans regularly experience acid indigestion, burning, and fullness that signal gastroesophageal reflux disease, GERD. For many patients, the path to an accurate diagnosis and appropriate treatment is not a simple one. Multiple tests can be required to pinpoint the precise cause and treatment for these complex digestive disorders.

The Cooper Digestive Health Institute is the first center in South Jersey to offer two innovative systems to more rapidly and accurately diagnose GERD.

The BRAVO™ pH Monitoring System is an ambulatory device used for detection and diagnosis of GERD. Using a wireless capsule that is placed in the esophagus, the system transmits data to a small, external receiver for 48 hours, as the patient continues normal activities.

In addition, Cooper is also now performing pH – Impedance Monitoring, a highly specialized test that is used to determine the specific type of reflux that the patient is experiencing. This specific identification aids in developing an individualized care plan.

“These tests provide a tremendous amount of very specific information on the digestive tract,” says Joshua P. DeSipio, MD, Cooper Digestive Health Institute gastroenterologist. “And, in the case of the BRAVO™ system, the patient is able to continue activities of daily life.”

“These specialized tests require not only advanced technology, but also expertise in interpretation,” says Steven R. Peikin, MD, Director, Cooper Digestive Health Institute, and Head, Division of Gastroenterology and Liver Diseases. “At Cooper we have the technology and the highest level of clinical interpretation and care.”

The Cooper Digestive Health Institute is also the only regional center to offer specialized diagnostic testing for swallowing difficulties, known as achalasia. Cooper is now performing High Resolution Manometry to measure pressure within the gastrointestinal tract to identify the origin of complex swallowing disorders.

For more information about capsule-based technologies, motility studies or other Digestive Health Institute services call: 856.642.2133.

Related Links

• Cooper Digestive Health Institute

The Harvard-based study, called Project VIVA and supported by the National Institutes of Health, was the first to evaluate the association between timing of solid food introduction during infancy and obesity levels at age three. Researchers analyzed data from 847 children enrolled in the long-term study of women and their babies, recruiting the women before they gave birth and evaluating the babies through their first three years.

Babies who were formula fed and introduced to solid foods before four months were 6.3 times more likely to be obese at age three. No association was found among breast-fed babies. Although it was unclear exactly why no association was found, medical experts speculate that breastfeeding mothers and babies are better able to recognize when the child’s appetite is satisfied.

Cooper pediatrician Beth A. Karmilovich, DO, agrees:

“It’s biological. The mother’s body is attuned to her baby. She produces the appropriate amount of milk for her baby’s nutritional needs, and the result is a child who is not over-fed, which may be the case with formula-fed infants,” Dr. Karmilovich said.

Such overfeeding not only is unhealthy for the child, the symptoms it causes can worry parents into making unnecessary or inappropriate choices.

“What often happens is, because the over-fed infant is vomiting, or gassy, or crying and seems uncomfortable, the parent will want to change the baby’s formula, or the parent assumes the child must still be hungry and begins adding solid foods to the diet, or the parent will think the baby has GERD (gastroesophagael reflux disease) and needs medicine.

“But, in many cases, it’s not what the baby is drinking, it’s how much,” Dr. Karmilovich said, noting that feeding a two-month-old baby an 8-ounce bottle every two to three hours is “clearly too much.”

“It’s important for parents to understand that every time a baby cries does not necessarily mean the baby is hungry. Babies like to suck, so they will participate when given a bottle, but overfeeding sets them up for discomfort, distress and obesity, not to mention the stress it can place on parents, families, and households.”

Dr. Karmilovich advises parents to maintain monthly pediatric appointments for their infants and to include discussion about feeding practices.

“At Cooper, pediatricians spend a lot of time explaining early infant feeding to parents, as well providing individualized weight and nutrition advice for pediatric patients of all ages. We keep close track of children’s weight and development, and we let parents know what’s appropriate for their child at every age. Whether it’s when to introduce solid foods to your infant or to advise you that your toddler is drinking too much juice and not enough milk, we help parents learn to keep their children healthy, fit and properly nourished,” Dr. Karmilovich said.

Related Links:

• Beth A. Karmilovich, DO
• Children’s Regional Hospital at Cooper
• Healthy Lifestyles, Healthy Children – Review the transcript of the recent Health eTalk hosted by Dr. Karmilovich

Gastroesophageal reflux disease, known as GERD, is a chronic digestive disease that occurs when acid produced by the stomach (to help digest the food we eat) refluxes (flows backward) into the esophagus. This results in the typical symptom of heartburn.

The esophagus, or food pipe, is an approximately 10-inch-long, one-inch-wide tube that leads from the mouth to the stomach. At its base is a muscular valve called the lower esophageal sphincter (LES). The LES opens to allow food into the stomach when we eat, and then closes to prevent the contents of the stomach from backing up into the esophagus. Sometimes, however, the sphincter doesn’t work properly, and the stomach acid enters the esophagus.

Acid that refluxes into the esophagus can cause irritation and heartburn. Other symptoms can include pain or tightness in the upper or middle chest, a sour or bitter taste in the mouth, soreness and burning in the back of the throat, hoarseness, coughing and difficulty swallowing.

While heartburn is a common digestive symptom that most people experience from time to time, frequent sufferers – more than twice a week – are particularly susceptible during the holidays, when high-fat treats at social gatherings, alcoholic beverages, and a host of other “offending” foods are more prevalent.

“The best way to prevent acid-reflux discomfort is to avoid the foods and beverages that cause the symptoms,” said gastroenterologist Andrew R. Conn, MD, of the Cooper Digestive Health Institute. “Pay attention to what you eat and drink, particularly if you know which of these will trigger your symptoms. During the holidays, things such as chocolate, caffeinated beverages and alcohol are typical foods that can result in heartburn,” Dr. Conn said.

Certain foods and ingredients are considered “offending” because they’re known to relax the function of the lower esophageal sphincter and thereby promote reflux. Not everyone experiences symptoms from all of the offending foods all of the time, but here are the ones to watch out for:

• Chocolate
• Peppermint
• Alcohol
• Caffeine
• Fats
• Spices
• Acidic foods and beverages (e.g., tomato- and citrus-based foods, juices and carbonated beverages)

In addition, smoking, consuming large meals, exercising soon after eating, being overweight, and eating snacks or meals less than 3 to 4 hours before lying down also can aggravate reflux.

“Most people can manage the discomfort of heartburn by making changes in their diet and lifestyle, and by taking over-the-counter medications. But for people with GERD, these remedies may offer only temporary relief. People with GERD may need stronger medications or other therapies to reduce symptoms, and to prevent erosion of and damage to the esophagus. Proper diagnosis and treatment is essential for those who suffer from frequent acid-related gastrointestinal discomfort,” Dr. Conn said.

– by Denice Ferrarelli

Related Links

• Andrew R. Conn, MD
• Cooper Digestive Health Institute

Here are some tips from the Children’s Regional Hospital at Cooper, where we have pediatric gastroenterologists ready to help children who may have this health issue.

Spit Happens

Gastroesophageal reflux (GER) is common in infants, and most babies outgrow it by the age of one. GER occurs during or after a meal when stomach contents go back into the tube that connects the mouth to the stomach. GER occurs often in normal infants. Most infants with GER are happy and healthy even though they spit up or vomit. Spitting up tends to peak at four months and most infants stop spitting up by 12 months of age.

If your baby is spitting up without discomfort and is making appropriate weight gains, then he or she is probably a normal spitter. Here are several recommendations which might help:

• Avoid overfeeding. Don’t feed the baby again after he or she spits up — wait until the next feeding.
• Consult your doctor to see if the baby is taking appropriately sized bottles or nursing the appropriate amount of time.
• For formula-fed infants, your pediatrician may recommend a special anti-reflux formula or that feedings be thickened with a small amount of infant rice cereal.
• For formula-fed infants, your pediatrician may advise you to try a formula created to be non-allergenic (hypoallergenic) for two weeks.
• Keep your infant upright for at least 30 minutes after meals.
• Only put your baby in a car seat when driving in the car.
• Avoid tight diapers and elastic waistbands.
• Avoid exposure to tobacco smoke.

Treating GERD

If your child is diagnosed with GERD, your doctor may recommend a few simple but important strategies, including:

• Time the evening meal so your child has an hour or two of quiet relaxation but nothing more to eat or drink before bedtime.
• For older children: After mealtime, have your child sit upright in a chair, reading, doing homework, or some other calm activity to give the digestive process time to work.
• Lying down soon after eating encourages the reflux of stomach contents into the esophagus. Your child may sleep more comfortably if you raise the head of her bed. Sleeping with the upper part of the body elevated uses gravity to discourage reflux.
• If your child is troubled by indigestion or other symptoms related to GERD, your pediatrician may also prescribe a medication to help her stomach contents move through the digestive tract more easily.

Youngsters and teenagers can also be bothered by GERD. The best advice is to talk to your pediatrician. If you are referred to a pediatric gastroenterologist, please call our board certified specialists at Cooper: Alan Baldridge, M.D., Division Head, or Sabeena Farhath, M.D.

Office Locations

Camden
Three Cooper Plaza, Suite 200
Camden, NJ 08103
Appointments: 856.342.2001

Voorhees
6400 Main Street
Voorhees, NJ 08043
Appointments: 856.751.9339

Related Links

• Pediatric Gastroenterology and Nutrition

Gastrointestinal problems affect more than a million people in the U.S. every year. Selecting the physicians and practice that provide the best care for your unique needs is extremely important.

The Cooper Digestive Health Institute, the largest outpatient gastroenterology center in South Jersey, provides patients with the most advanced testing and treatment in a state-of-the-art outpatient facility. Cooper gastroenterologists diagnose and treat many complex disorders and diseases of the digestive tract, but one of the more prevalent health problems being seen in patients is gastroesophageal reflux disease (GERD).

GERD is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus. Heartburn is the most common symptom of GERD and is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. For most people, over-the-counter antacids can help, but the cause of the problem remains.

“People that tend to be overweight, smoke, overeat and consume a lot of caffeine or alcohol are more susceptible to this disorder,” said Steven R. Peikin, M.D., Director of the Cooper Digestive Health Institute and author of GERD: It’s More Than Just Heartburn. “I think what some people don’t realize is in many cases, gastroesophageal reflux disease can be prevented through simple diet and lifestyle changes.”

Some ways to manage heartburn include the following:

• Monitor the medications you are taking – some may irritate the lining of the stomach or esophagus.
• Quit smoking.
• Eat smaller portions.
• Do not lie down or go to bed right after a meal.
• Limit alcohol consumption.
• Elevate the head of the bed six inches.
• Lose weight, if necessary.

If you’d like to learn more about GERD, including available treatment options, we invite you to download and read GERD: It’s More Than Just Heartburn, a free eBook by Dr. Steven Peikin, online at cooperhealth.org/gerd.

Related Links

• Cooper Digestive Health Institute
  Located at 501 Fellowship Road in Mount Laurel, New Jersey, the Cooper Digestive Health Institute staff is committed to implementing innovative medical techniques and maintaining excellence in patient care, while offering a full range of gastrointestinal services.
• Download Your Free Digestive Health eBook
  This short book is available free as an Adobe PDF; an EPUB file, which can be viewed on a number of devices including the iPhone and Sony eReader; or a MobiPocket file, which can be viewed using a Kindle, Blackberry and other mobile devices.