Dr. Michael Kimmey is the director of Gastrointestinal Endoscopy at the Digestive Disease Center and section chief of Gastroenterology at University of Washington Medical Center. He was the president of the American Society for Gastrointestinal Endoscopy in 2000 – 2001 and has participated in a variety of research projects connected to this field.
Reflux1: What is your area of expertise?
Dr. Kimmey: I am a gastroenterologist so I specialize in gastroenterology and especially therapeutic gastrointestinal endoscopic procedures such as endoscopic ultrasound, pancreaticobiliary endoscopy (ERCP) and photodynamic therapy (PDT) for the early diagnosis and treatment of gastrointestinal and pancreatic cancers.
|Advice From the Physician|
“The best patient is an educated and motivated patient. You can only accomplish so much in a short visit with the doctor and you can accomplish so much more if the patient comes in with some knowledge of what is wrong with them in advance.”
– Dr. Kimmey
Reflux1: How did you come to specialize in this field?
Dr. Kimmey: I did my gastroenterology training after residency and became interested in endoscopy. I’ve sort of grown up with the field and have picked up the new techniques that have come along as they have been developed. I was one of the pioneers in the field of endoscpic ultrasonography and I worked on the development of devices and did some of the early research work showing how ultrasound findings correlate with histopathology (editor: The science concerned with the study of microscopic changes in diseased tissues). Endoscopy is commonly used for the diagnosis and staging of gastrointestinal cancer – so I guess that is how I really got involved in that area.
Reflux1: Since 1998 you consistently have been voted one of America’s top doctors. What is the most important advice you would give a doctor starting out in this field?
Dr. Kimmey: Listen to your patients. They will tell you what is wrong with them and you should pay attention to what they say. Listen to them and follow up on every detail and be meticulous about the care you give them.
Reflux1: What’s the biggest challenge in this field and in caring for people with reflux?
Dr. Kimmey: The biggest challenge is that this is a life-long disease and we intervene at one point in time, yet patients don't stay the same forever. We have to try and manage the patient so that they have a good quality of life and don’t have any complications from their reflux. We also need to make sure that they don’t have complications from their treatments.
Reflux1: What are the usual treatments for reflux?
Dr. Kimmey: Traditionally, this condition has been treated with medication to reduce stomach acid secretion or surgery to re-create the valve at the bottom of the esophagus. This procedure used to be done through an open operation then it was done laparoscopically but still requires a one to two day hospital stay and a general anesthetic. The new endoscopic procedure can be done in a shorter time frame with only moderate sedation.
Reflux1: How are these new procedures changing the way we handling gastro-related problems?
Dr. Kimmey: Well, we have gotten a whole lot less invasive. We are using endoscopes through normal body orifices to diagnose problems at a very early stage when they can be treated endoscopically without open surgery – I think that is the main change.
Reflux1: What does your research project – Endoscopic Implantation of Enteryx involve?
Dr. Kimmey: This is a post-marketing study trying to show in a larger number of patients that this is a safe and effective procedure for treating gastroesophageal reflux disease.
Reflux1: Could you describe the endoscopic procedure?
Dr. Kimmey: The procedure involves passing a lighted flexible tube through the mouth into the esophagus after the patient has been given medicine in their vein to make them relax. Then we inject a polymer substance into the sphincter muscle at the bottom of the esophagus. We use x-rays to guide the injection into the right location and this bulks up the sphincter muscles to reduce the amount of reflux that occurs from the stomach.
Reflux1: Who would be the best candidate for this kind of procedure?
Dr. Kimmey: I think the best candidates are those patients who have reflux disease, heartburn, regurgitation, and some stomach contents in their esophagus who have responded to medical therapy. They are tired of taking pills and would like to have something done that is more definite that doesn’t require ongoing medical therapy.
Reflux1: Is this a day operation?
Dr. Kimmey: It’s an out-patient procedure. It takes about 30 minutes.
Reflux1: Are there any complications?
Dr. Kimmey: Patients have side effects from the medications and can have problems with bloating and excessive gas, as well as pain after laparoscopic surgery. They can also have side effects from the endoscopic procedures. Some people may have discomfort in the chest and upper abdomen for several days after the procedure and there have been a few serious complications reported that are fortunately quite rare.
Reflux1: If my reflux returned or worsened after the procedure could I try the procedure a second time?
Dr. Kimmey: Yes, you can have it again and it also doesn’t preclude you from having medicine or surgery.
Reflux1: Do you find that most of your patients are using this procedure in combination with their medication?
Dr. Kimmey: Most of our patients have the procedure one time, and they are able to get off their medications or at least lower the medication.
Reflux1: This procedure sounds like it’s suitable for everyone. Is there anyone who couldn’t have this procedure done?
Dr. Kimmey: People with big hiatal hernias or severe reflux would not respond to this procedure. This procedure is not likely to take away all their symptoms, so we tend to use it with patients who have more moderate degrees of reflux.
Reflux1: What other treatments would you recommend for someone who couldn’t have the procedure done?
Dr. Kimmey: We would have to go back to medical therapy – acid-reducing medicine or possibly open or laparoscopic surgery.
Reflux1: We have been hearing a lot about reflux lately. Is this disease a symptom of modern life or have we just gotten better at diagnosing an existing condition?
Dr. Kimmey: I think it’s a common problem that is increasing in frequency, most likely related to our diets and our increasing problems with being overweight. Both fatty diets and being overweight predispose people to gastroesophageal reflux disease (GERD).
Reflux1: Is this another hidden health problem that obesity brings?
Dr. Kimmey: Well, you don’t just have to be obese, just overweight. Even young, thin people also suffer from reflux. For most people it starts in their 40s and 50s.
Reflux1: When someone develops reflux can they control the problem with diet?
Dr. Kimmey: They can improve it generally with diet, which means losing weight. Also going to bed with an empty stomach so that you eat the last meal of the day at least three hours before you fall asleep can help. You should also avoid fatty foods.
Reflux1: What about acidic foods?
Dr. Kimmey: Acidic foods generally don’t make reflux worse. Lemons and tomatoes contain citric acids, which are a very mild acid and are weak compared to the amount of very strong hydrochloric acid the stomach makes every day. When foods bother people in a certain way, I recommend that they avoid them; however, they are not going to cause any damage.
Reflux1: Have you seen more women than men suffering from acid reflux?
Dr. Kimmey: I think it’s slightly more common in men but not that much. Women get it too.
Reflux1: You were one of the principle creators for the Washington University publication “Gastroenterology and Hepatology for the Primary Care Provider: Principles, Practice & Guidelines for Referral.” This is a very innovative Web site with pop-up screens and flowcharts. Was this intended for public use?
Dr. Kimmey: Well, the original concept was to help primary care doctors know when they need to refer their patients to a gastroenterologist. So, it was really designed for primary care doctors, but I think a lot of patients can find some very useful information there. It’s not written with highly-technical terms and it’s in the public domain.
Reflux1: Do you think it’s important for someone with reflux to educate themselves and understand as much as they can about the condition?
Dr. Kimmey: Yes, absolutely. This is true with acid reflux as well as every other health condition. The best patient is an educated and motivated patient. You can only accomplish so much in a short visit with the doctor and you can accomplish so much more if the patient comes in with some knowledge of what is wrong with them in advance. They will have the best questions for the doctor. Patients should write down their questions so they can maximize the benefit of their time with the doctor.