Guest: Dr. Abhinav Sankineni
Presenter : Neal Howard
Guest Bio: Abhinav Sankineni, MD, MPH, is board certified in internal medicine. Dr. Sankineni attended the Kamineni Institute of Medical Sciences in Andhra Pradesh, India, where he earned his medical degree. He completed his residency at Abington Memorial Hospital and his fellowships in advanced endoscopy, gastroenterology and gastrointestinal motility at Temple University Hospital. Additionally, Dr. Sankineni holds a master’s degree in public health from West Virginia University. Dr. Sankineni specializes in interventional gastroenterology, endoscopic esophageal pH testing, esophageal motility studies, and esophageal and biliary stenting.
Segment overview: In this segment, Dr Abhinav Sankineni, gastroenterologist at MedStar Franklin Square Medical Center talks about unique esophageal motility testing for people with swallowing issues.
Health Professional Radio – Esophageal Motility Testing
Neal Howard: Welcome to the program. I’m your host Neal Howard on this Health Supplier Segment here on Health Professional Radio. Glad that you could join us today. Our guest in studio is Dr. Abhinav Sankineni, he is board certified in internal medicine and he is here with us today to talk about some unique motility testing for people who are having swallowing issues. Welcome in the Health Professional Radio doctor.
Dr. Abhinav Sankineni: Good morning, how are you doing?
N: I’m doing well. Tell our listeners a little bit about yourself. What is your background?
S: I’m a board certified in internal medicine and board certified in gastroenterologist. I’m practicing gastroenterologist right now at the MedStar Franklin Square Hospital in Baltimore. I trained at Temple University Hospital and I spent doing three fellowships there – one is a regular gastroenterology fellowship then followed by, I did a one year of fellowship in the gastrointestinal motility and then I did one more year of interventional gastroenterology. Temple being a center for excellence for motility problems, both esophageal and lower GI (gastrointestinal) motility problems, I spent time with the experts in the field for at least one year learning the unique esophageal motility problems under the world experts. I also do interventional gastroenterology in dealing with pancreatic interlobular stuff.
N: There been some pretty substantial advances in testing for people that are having issues swallowing whether it be liquid or they’re own just swallowing, or food. Talk about some of these unique esophageal motility testing?
S: To begin with, patients or individuals when they swallow, the food goes from the mouth then through the food pipe, others call it ‘Esophagus’ which acts as a transit, helps transit, transfer this food from the mouth to the stomach. If somebody is having any trouble swallowing, meaning if the food either solids or liquids getting stuck in the esophagus, they should seek a gastroenterologist to make sure there’s no problem in the esophagus. The main concern with somebody that has swallowing issues is to make there’s no cancer. When there’s no evidence of narrowing of the food pipe, there may be a problem with the functioning of the esophagus. Meaning, there may be a problem either transporting this food either solids or liquids from the mouth to the stomach, or there’s a muscle at the lower part of the esophagus which opens up when the food is in the esophagus and helps transfer the food from the esophagus to the stomach. This muscle closes when the food is in the stomach to prevent the acid coming back up into the esophagus. So there may be problem in that part of the muscle, this need to be further evaluated. What we offer at the Franklin Square Hospital is an esophageal motility testing. These are specialized testing with pressure sensors for which the patients have to be awake and it goes from their nose into their esophagus and the stomach and patients are asked to swallow. And when they swallow, we assess the esophageal contractions and also the muscle which opens up at the lower part of the esophagus. This provides a lot of information and accordingly treat patients.
N: The patient has to be awake in order to follow the command to swallow when that happens. Do you find that there are different reasons for the swallowing issues that make it more difficult or less difficult when the patient is undergoing this testing?
S: Our nurses who do this procedure are specifically trained for this to perform these procedures. They do all the precautions and 99% of the time, patients are able to do this procedure. However, sometimes when the muscles, the lower part of the esophagus is too tight and it doesn’t open up. The catheter may not pass from the esophagus into the stomach. In those special situations, we do an endoscopy before the procedure and put that catheter down there and then once the patients are awake then we do the procedure.
N: How much video is involved in this testing? You mentioned pressure sensors, is it completely pressure sensor oriented or are there times when a picture is worth more than the pressure sensors?
S: The technology right now using this pressure sensor is a high resolution manometry, meaning we get topographic pictures. Because these are continuous pressure sensors, depending on the way their esophagus is contracting we get enough high resolution topographic pictures which give a lot of information. Previously, this used to be done under water perfused and they used to be tracings, but now we have topographic pictures which give us a lot of information. However, even before this is done, we do an endoscopy to make sure there’s nothing sinister going on.
N: Are the same type of procedures effective when someone is determined that they are going to need a feeding tube. Is that testing, is it the same type of testing or once they get to that point, is testing no longer needed and simply the treatment is administered as best as can be?
S: We don’t do this testing prior to the feeding tube. However, we do this testing prior to patients undergoing anti-reflux procedures or sometimes bariatric procedures. The reason we do this testing before anti-reflux or bariatric procedures is because if they have acid reflux and trouble swallowing before these procedures are performed and if these are undiagnosed before an anti-reflux procedure or a bariatric procedure, sudden bariatric procedures, this can worsen their situation. So the pre-testing, we do offer this test to make sure there’s no underlying problems to their esophagus or the muscle which opens up at the lower part of the esophagus.
N: In your experience doctor, have you noted any unexpected benefits of this testing? For instance maybe not only discovering or ruling out a problem with the esophagus but maybe discovering something even deeper maybe toward the stomach or maybe in the mouth where before maybe just some added benefit where you can get a little bit more information and maybe identify other problems.
S: Yes. When we do this testing, we are assessing the esophageal muscle contractions and the muscle at the lower part of the esophagus. At the same time, when patients are having troubles swallowing there could be something outside the esophagus which could be compressing, which could be missed on the endoscopy and if you don’t pay attention, even on the CT scan. There are times when their blood vessels in the chest, which run across the esophagus compresses the esophagus causing them trouble swallowing. When we do this motility testing we can identify that as a vascular artifact and we do further testing and there been times when we have to refer those patients for further evaluation. Also, when the lower part of the esophagus does not open even though upper part of the esophagus seems to be okay, we do further testing and we have found a tumor outside the esophagus compressing which have been missed on the endoscopy and the CT scan and when we do this testing, we find out these problems.
N: Are all of the different types of testing that you offer there, are they all covered by most insurance and Medicaid? Or are these, some of these procedures an out-of-pocket expense for the patient?
S: No. These are all covered by the insurance if it is indicated and the majority of the times when we subject these patients to this test and it goes are indicated the patients don’t have trouble paying through their insurances.
N: Talk about your website and what would we expect to find there?
S: Right now, my information is on the MedStar health system. If you either Google me or if you go to MedStar health, and then you type my name you’ll get my information, my education and also I have a short video talking about esophageal problems, all that is on my website. I have bunch of publications from my training that we have published and these will be added to my website shortly and they will be available to be viewed.
N: Great. In wrapping up doctor, are there any limitations as far as age that you’ve noticed with this testing? Is there an age limit where this person is too young or too old to benefit from this type of testing?
S: No. The main benefit of this testing is the patient don’t need sedation, there is no risk of anesthesia with these procedures. It’s a day procedure done in an office, so there’s no age limit and there’s no risk, major risk associate with this procedure.
N: It’s been a pleasure talking with you today, doctor.
S: It was my pleasure.
N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard here on this Health Supplier Segment with Dr. Abhinav Sankineni, board certified in internal medicine and we’ve been discussing motility testing for folks who are having swallowing issues. Transcripts and audio of this program are available at healthprofessionalradio.com.au also at hpr.fm, you can subscribe to this podcast on iTunes and listen in and download at SoundCloud.