When a Simple Activity Becomes Difficult: Providing Solutions for Swallowing Disorders

They are desperate for relief and answers, coming from the southeast region and beyond for help with a basic human function: swallowing. Whether their esophageal issues are complex or common, gastroenterological patients at Tampa General Hospital benefit from a nationally-renowned multidisciplinary treatment – and a unique legacy that took root four decades ago.

Their care flows from the latest surgical techniques and innovative approaches for handling a wide range of esophageal disorders – supervised by a world-class team headed by Dr. Joel Richter.

“A great deal of misinformation and misdiagnosis exists with esophageal disease,” Dr. Richter said. “Across the United States some 10-15 percent of people have that problem – the food doesn’t go down. If you’re over the age of 65, the percentage is more like a third of the population. We look at every case from a multidisciplinary approach of what is best for the patient. It’s never a ‘one mechanism fits all’ philosophy.”

The internationally renowned gastroenterologist, who specializes in complicated esophageal diseases, provides a link for TGH patients to the resource of the Joy McCann Culverhouse Swallowing Center at the USF Health Morsani College of Medicine.

As the Hugh Culverhouse Endowed Chair for Esophagology since 2011, Dr. Richter brings vast knowledge, experience and training from some of the nation’s most recognized medical centers to diagnosing and treating patients at TGH, where he is a member of the medical staff.  His patients suffer from a wide range of esophageal maladies that impact their ability to swallow food and can significantly curtail their quality of life.

Patients who come to Tampa General or are later treated by Dr. Richter and his team at the Swallowing Center, have often been seen by other gastroenterologists with less experience treating swallowing disorders. They are frightened and frustrated, and often have lost hope of finding a solution to their problem, Richter explained.

 “We see people who have lost 20-25 pounds and have gone on a liquid diet because they are unable to swallow normally,” he said. “I’ve seen patients with misdiagnosed achalasia, when their doctor thought they were having aspiration pneumonia and wanted to give them feeding tubes. Our team’s specialized expertise ensures that we are able to evaluate and treat everyone appropriately.”

Patients are treated for conditions from “A to Z,” Dr. Richter said, including eosinophilic esophagitis, esophageal motility problems such as achalasia, GERD, a wide array of ENT issues, and more. The toolbox for treatment is extensive: high resolution manometry, Bravo pH and impedance-pH tests, pneumatic dilation, esophageal Botox injections, and complicated dilation of esophageal strictures.

A new advanced surgical endoscopy – Per-Oral Endoscopic Myotomy (POEM) – is also performed at TGH by Dr. Christopher DuCoin, who learned the procedure training in Germany. It is designed to treat achalasia, a constricting of the lower esophagus that impairs eating and can produce dangerous weight loss.

“I regard it as a puzzle,” says Richter. And our job is to figure it out with our team of experts. Together, we determine and provide the best treatment possible for our patients.”