Diagnosing Heartburn - Gastroenterologists Diagnose Chronic Heartburn More Effectively

December 1, 2008 — Gastroenterologists are using confocal laser endomicroscopy (CLE) to more effectively diagnose chronic heartburn. The technology gives doctors an image of the esophagus that is magnified 1,000 times. A tiny microscope at the end of an endoscope provides the magnification, while a blue light provides illumination--sending clear, close-up images to a computer screen.

Pain and discomfort from heartburn or acid reflux is common -- but when symptoms become severe, it could mean a more serious problem. A new technology is changing the way gastrointestinal disorders are detected.

Imagine if every time you ate, a painful, fiery sensation burned through your chest. That's what eating was like for heartburn patient Anne Walters. She suffers from chronic, painful heartburn.

"It got to a point where it didn't matter what I ate," said Walters. "I was constantly uncomfortable." To find out the cause of discomfort like hers, gastroenterologists now have a new technology called confocal laser endomicroscopy (CLE). It shows extreme close-up images of the esophagus and helps doctors better diagnose gastrointestinal disorders.

"It magnifies the lining of the esophagus or other parts of the gastrointestinal tract about 1,000 times normal size, so it's like looking under a microscope and seeing cells," said Kerry Dunbar, M.D., a gastroenterologist at Johns Hopkins Hospital in Baltimore, Md.

The key to the technology is a tiny microscope at the tip of an endoscope -- a flexible, lighted device that's used to view inside the body. A blue light shines inside the body and the images are sent back to a computer. During the procedure, the doctors see the images on the screen.

"One of the advantages of the confocal laser microscope is that we can often make a diagnosis right then," Dr. Dunbar said.

Thanks to the new device, doctors can immediately identify pre-cancerous cells and other disorders and treat them more quickly.

Walters learned she had acid reflux and Barrett's Esophagus -- a risk factor for cancer. With regular check-ups and medications, she's now heartburn-free.

"It makes a wonderful change in my life to feel better," Walters said.

The CLE technology is currently in clinical trials across the country. So far, it has been 95 percent accurate in diagnosing pre-cancerous cells.

HOW DOES DIGESTION WORK? When we consume food, it is not usually in a form that the body can use as nourishment. First, it must be converted into smaller molecules of nutrients, which can be absorbed into the blood and carried to cells throughout the body, providing the necessary fuel to function. This is the job of the digestive system: a series of organs joined by a long, twisting tube that runs from the mouth to the anus. Food enters the esophagus through the mouth. The esophagus connects the throat and the stomach. There is a ring-like valve where the esophagus meets the stomach, which relaxes to allow food to pass into the stomach before closing up again. The stomach stores the food and liquid, and then mixes it all up with digestive juices. The walls of the stomach and the digestive system's other major organs contain muscles, which enable them to move, propelling food and liquid through the digestive tract by squeezing itself like a wave. This is called peristalsis.

Once the stomach has emptied its contents into the small intestine, the partially digested food is dissolved even further by juices produced by the pancreas, liver and intestine. Then it is mixed and pushed along even further as nutrients are absorbed through the intestinal walls into the bloodstream. Waste products include undigested parts of food, like fiber, as well as older cells that have been shed from the intestinal walls. These are passed into the colon before being excreted by the body.

WHAT ARE LASERS: "Laser" stands for Light Amplification by Stimulated Emission of Radiation. It describes any device that creates and amplifies a narrow, focused beam of light whose photons are all traveling in the same direction, rather than emitting every which way at once. An opposite example would be a flashlight, where the atoms release their photons randomly in all directions. Laser light contains only one specific color, or wavelength. The type used in this confocal laser endomicroscope produces blue light.

The Optical Society of America contributed to the information contained in the TV portion of this report. 

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Note: This story and accompanying video were originally produced for the American Institute of Physics series Discoveries and Breakthroughs in Science by Ivanhoe Broadcast News and are protected by copyright law. All rights reserved.