Roger D. Mitty M.D. has served as chief of endoscopy and staff physician in the section of gastroenterology at St. Elizabeth’s Medical Center of Boston from 1994 to the present. During that time Mitty has also been an assistant professor of medicine at Tufts University School of Medicine in Boston. He currently serves as president of the New England Endoscopy Society.
Reflux1: How has your particular specialization or research interests informed your understanding of gastrointestinal disorders and diseases?
Dr. Mitty: The more you practice the more you realize that every patient is different. In terms of acid reflux, there are different therapies depending on the symptoms patients present. For example, patients that have hiatal hernias can’t have the Enteryx procedure and need to consider surgery. Learning to tailor therapies to patients is something that takes time in a practice.
I also think that patients need to be encouraged to ask what choices there are for acid reflux. They need to be smart consumers. Many patients just accept the idea that pills are the only answer. So patients need to be encouraged to be proactive to ask physicians what their alternatives are in the areas of endoscopy and Enteryx.
Reflux1: Have you undertaken any research that has influenced your profession beyond your local practice?
Dr. Mitty: I think some of the things we’ve done have changed approaches to endoscopy and sedation techniques, as well as the way we treat patients that have certain cancers.
With endoscopy, for instance, we now know that when we sedate patients for the procedure we’re better able to perform a colonoscopy test. Sedation keeps patients comfortable so they not only wake up with no ill memories, they have no pain during the procedure. The other side of the coin is that sedation needs to be done very safely, so we walk a line making sure that there are no adverse outcomes like high blood pressure or trouble with breathing. We’ve gotten so busy doing endoscopies, though, that we are getting good at controlling sedation. In particular, our work with EEG monitors has enhanced our ability to direct sedation as well as to help decide with drugs to use and when to use them.
In the area of cancers, we’ve found that certain devices work better than others. When a cancer grows in the bile ducts connecting the liver and gallbladder to the small intestine, the ducts can become blocked, and patients become jaundiced. What stents do is keep the duct open, and our work shows that coated metal stents work better than plastic ones.
Reflux1: Can you discuss the major strengths and weaknesses of gastrointestinal endoscopy?
Dr. Mitty: The benefits of endoscopy is that it’s incredibly safe. Also, with endoscopy we have the opportunity to both diagnose and treat problems. Problems that would have formerly required surgery can now be treated with endoscopic therapy. As a field, we’ve made great strides in that area.
I don’t think endoscopy has any major weakness, although it is still an invasive procedure that has a tiny bit of risk. That said it is not as invasive as surgery. Also, the scopes we have today are more flexible and refined. That along with sedation makes the procedure considerably easier for patients to tolerate than it was 30 years ago.
Reflux1: What type of relationship do you think exists between rising rates of reflux (GERD), obesity, and adenocarcinoma of the esophagus?
Dr. Mitty: We know there is a relationship between reflux , Barrett’s esophagus, and adenocarcinoma from a study done in Sweden. So there is a very clear correlation there.
That same study also showed people with obesity, particularly those that carry extra weight at the belly, are high risk for developing Barrett’s and often adenocarcinoma of the esophagus. While aren’t sure why there is a connection to obesity, it might be because of intra-abdominal pressure. The question is it is just because they are obese or do they have more acid reflux because they are obese. It is a fascinating question.
Reflux1: What questions do your patients frequently ask you and what are your answers?
Dr. Mitty: When we put patients on a pill, they usually ask if they will need to take it forever. While some patients are able to stop taking medicines for periods without symptoms coming back, the vast majority are required to stay on the medications their whole life.
Patients also want to know what other options they have. That’s when we discuss surgical treatment and the Enteryx procedure where we inject a liquid into the sphincter muscle between the stomach and esophagus to keep acid from backing up.
Some patients also want to know if there are any habits they can change, but it’s my feeling that by the time they come to see a specialist they are beyond the point at which lifestyle intervention will help.
Reflux1: From your place as a physician specializing in gastroenterology, what if anything do you wish the American population would do differently as far as preventive self-care.
Dr. Mitty: I think there are two major lifestyle habits that are important for everyone no matter what disease we’re talking about. The first is: Don’t go near cigarettes - ever. As far as gastroenterology is concerned, cigarettes increase the stomach’s acid output and can certainly create higher opportunities for ulcers and acid reflux. The second is: Make sure you exercise and don’t become obese. We really need to make sure exercise is big part of American lifestyle, and right now it isn’t nearly big enough. Exercise is critical in helping people maintain weight loss and avoid gaining and losing the same 10 pounds over and over again like I see so many people in their 20s and 30s do.
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