Dr. Arnon Lambroza - specialist in esophageal disorders, gastroenterology, liver disease as well as swallowing disorders.

Gastroesophageal Reflux Disease
Achalasia
Gastroparesis
Eosinophilic Esophagitis
Background

Arnon Lambroza, M.D.

950 Park Avenue
New York, New York 10028
Tel: (212) 517-7570
Fax: (212) 517-7789
Gastroenterology
Esophageal and Swallowing Disorders
Gastrointestinal Motility Disorders

Dr. Arnon Lambroza is a gastroenterologist who specializes in esophageal and swallowing disorders, including gastroesophageal reflux disease, Barrett's esophagus, achalasia and diffuse esophageal spasm. He is also an expert in the diagnosis and treatment of gastrointestinal motility disorders such as gastroparesis (delayed gastric emptying), irritable bowel syndrome and constipation.
Dr. Lambroza performs upper endoscopies and colonoscopies, as well as highly specialized gastrointestinal function tests such as esophageal manometry, 48-hour wireless pH studies (Bravo pH probe) and esophageal impedance-pH testing. He is one of the few physicians in the country experienced in managing patients with gastroparesis who have received a gastric electrical stimulator (“gastric pacemaker”).

[Top]

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common disorder which is characterized by the excessive backflow of stomach contents into the esophagus. Patients with GERD can experience a variety of symptoms including heartburn, regurgitation, acid indigestion and a bitter or sour taste in the mouth. They may also experience less typical symptoms such as a chronic sore throat, chronic cough, hoarseness, asthma and chest pain.
One of the long-term complications of GERD is a condition known as Barrett's esophagus. This disorder is characterized by the replacement of normal esophageal lining cells with intestinal cells. Because these intestinal cells may sometimes develop into cancer, patients with Barrett's esophagus should undergo periodic surveillance examinations of the esophagus. Dr. Lambroza is currently participating in a clinical study examining the effects of Polyphenon E (a green tea extract) in patients with Barrett's esophagus.

There have been dramatic advances in the medical and surgical treatment of GERD in the last fifteen years. The proton-pump inhibitors (Prilosec, Nexium, Prevacid, Aciphex and Protonix) are potent acid-suppressing drugs which have helped many patients who were previously refractory to medical therapy. Patients with GERD who are responding poorly to medication, or who wish to avoid taking drugs, may be candidates for a surgical fundoplication. In this procedure, a portion of the stomach is wrapped around the esophagus in order to tighten the lower esophageal sphincter (the muscle responsible for preventing reflux). This procedure can now be performed through a laparoscopic, minimally-invasive approach which dramatically reduces the discomfort and recuperative time of the operation. Most patients considering surgery should undergo esophageal motility and ambulatory pH studies to determine whether the surgery is indicated and, if so, what type of operation should be performed.

Three new endoscopic techniques have been approved for patients with GERD who do not want to take medications or have surgery. These techniques are performed by a gastroenterologist in the outpatient setting and are known as endoscopic suturing (EndoCinch procedure), radiofrequency wave ablation of the lower esophageal sphincter (Stretta procedure) and endoscopic plication (NDO plicator). The proper role of these procedures in the long-term management of GERD continues to be evaluated.

[Top]

Achalasia

Achalasia is an esophageal motility disorder that is characterized by the severe retention of food in the esophagus. In patients with achalasia, the esophagus loses its ability to contract in a sequential manner and the lower esophageal sphincter fails to open completely, thereby preventing the normal flow of food into the stomach. Patients with achalasia feel that food gets stuck in their throat or chest and they may experience severe regurgitation and weight loss.
Achalasia results from the loss of nerve cells within the muscular wall of the esophagus. The reason for this nerve cell loss in unknown. Achalasia is treated by decreasing the lower esophageal sphincter pressure with oral medications, balloon dilation, injection of botulinum toxin (Botox) or surgery. Dr. Lambroza has counseled many patients on the appropriate treatment of their achalasia and has performed a large number of balloon dilations and Botox injections.

[Top]

Eosinophilic Esophagitis

Eosinophilic esophagitis (EE) is a chronic inflammatory disorder that is characterized by a dense infiltration of eosinophils in the wall of the esophagus. Eosinophils are white blood cells that are involved in certain allergic conditions. Patients with EE typically complain of solid food getting stuck in their throat or chest upon swallowing. Since these patients may also experience heartburn, nausea and chest pain, they are often misdiagnosed as having GERD (although the two conditions may coexist). Patients with EE experience trouble swallowing due to the esophageal strictures and rings that develop as a result of the eosinophilic infiltration. The esophageal findings of EE, which include linear furrows, multiple rings and fine white exudates, are often subtle and unrecognized at the time of endoscopy. The diagnosis of EE is made by obtaining biopsies from several locations in the esophagus and finding more than 15-20 eosinophils per high power field under the microscope. The cause of EE is thought to be an allergy to a swallowed or inhaled allergen. Therapy for eosinophilic esophagitis includes a food elimination diet, swallowed steroids (fluticasone) and/or esophageal dilation.
Read Article:
Eosinophilic Esophagitis by Arnon Lambroza, M.D.

[Top]

Gastroparesis

Gastroparesis is a gastric motility disorder that is characterized by delayed stomach emptying in the absence of a mechanical obstruction. The characteristic symptoms of gastroparesis include nausea, vomiting, bloating and early satiety. Abdominal pain may be a prominent symptom in some patients. The diagnosis of gastroparesis requires ruling out other causes of nausea and vomiting, such as peptic ulcer disease, gastrointestinal infection, pancreatic disease, hormonal disorders and medication side effects. The most common cause of gastroparesis is diabetes. Some patients develop gastroparesis following an episode of viral gastroenteritis.
A gastric emptying study is usually performed to objectively document a delay in gastric emptying. This test involves ingesting a radiolabled meal of scrambled eggs, bread and jam and then laying under a camera which measures the length of time required for the meal to pass from the stomach into the small intestine.

The treatment of gastroparesis begins with dietary management. Patients should eat smaller, more frequent meals and should avoid fatty foods, fibrous foods, red meat and fresh vegetables. Meals that are rich in protein and starches are preferred because they are more easily mixed and emptied by the stomach. Many patients require medical therapy with anti-nausea and/or pro-motility drugs. Botox injections into the pyloric sphincter of the stomach may sometimes also alleviate the symptoms of gastroparesis.

The vast majority of patients with gastroparesis can be successfully managed with dietary and medical therapy. Patients with refractory nausea and vomiting who require periodic hospitalizations and/or dietary support via intravenous nutrition or direct small intestinal feeding, may be candidates for a novel therapy known as gastric electrical stimulation. This involves a device, known as Enterra (Medtronics, Inc.), which consists of a neurostimulator that is implanted in the abdominal wall, along with two wires that lead from the stimulator to the stomach. The Enterra device provides a direct electrical stimulation to the stomach and can dramatically improve symptoms of nausea and vomiting in some patients.

Read Article:
Gastroparesis by Arnon Lambroza, M.D.

[Top]

Background

Dr. Arnon Lambroza is a board-certified gastroenterologist and an attending physician at the New York-Presbyterian Hospital/Weill-Cornell Medical Center. He is a graduate of the Albert Einstein College of Medicine, where he was elected to Alpha Omega Alpha (AOA), the national medical honor society. Dr. Lambroza performed his internship and residency in Internal Medicine at the Hospital of the University of Pennsylvania, followed by a fellowship in Gastroenterology at the New York Hospital-Cornell Medical Center.
Upon completing his fellowship, Dr. Lambroza joined the staff of the New York Hospital-Cornell Medical Center, where he was the founder and director of The Center for Esophageal and Swallowing Disorders, a unique multi-disciplinary program dedicated to treating patients with gastroesophageal reflux disease, esophageal motility disorders and difficulty swallowing. For the past 16 years he has led a monthly conference that presents cases of complex esophageal and swallowing disorders to a panel of experts in radiology, general and thoracic surgery, otolaryngology, speech pathology and rehabilitation therapy. Dr. Lambroza lectures widely on esophageal and gastrointestinal motility disorders and is the past-president of the New York Society for Gastrointestinal Endoscopy.

For more information on esophageal and gastrointestinal motility disorders please contact our office.

[Top]

Arnon Lambroza M.D.
950 Park Avenue
New York, New York 10028
Tel: 212-517-7570
Fax: 212-517-7789

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Arnon Lambroza, M.D.
	950 Park Avenue New York, New York 10028 Tel: (212) 517-7570 Fax: (212) 517-7789 Gastroenterology Esophageal and Swallowing Disorders Gastrointestinal Motility Disorders Dr. Arnon Lambroza is a gastroenterologist who specializes in esophageal and swallowing disorders, including gastroesophageal reflux disease, Barrett's esophagus, achalasia and diffuse esophageal spasm. He is also an expert in the diagnosis and treatment of gastrointestinal motility disorders such as gastroparesis (delayed gastric emptying), irritable bowel syndrome and constipation. Dr. Lambroza performs upper endoscopies and colonoscopies, as well as highly specialized gastrointestinal function tests such as esophageal manometry, 48-hour wireless pH studies (Bravo pH probe) and esophageal impedance-pH testing. He is one of the few physicians in the country experienced in managing patients with gastroparesis who have received a gastric electrical stimulator (“gastric pacemaker”).
[Top] Gastroesophageal Reflux Disease
	Gastroesophageal reflux disease (GERD) is a common disorder which is characterized by the excessive backflow of stomach contents into the esophagus. Patients with GERD can experience a variety of symptoms including heartburn, regurgitation, acid indigestion and a bitter or sour taste in the mouth. They may also experience less typical symptoms such as a chronic sore throat, chronic cough, hoarseness, asthma and chest pain. One of the long-term complications of GERD is a condition known as Barrett's esophagus. This disorder is characterized by the replacement of normal esophageal lining cells with intestinal cells. Because these intestinal cells may sometimes develop into cancer, patients with Barrett's esophagus should undergo periodic surveillance examinations of the esophagus. Dr. Lambroza is currently participating in a clinical study examining the effects of Polyphenon E (a green tea extract) in patients with Barrett's esophagus. There have been dramatic advances in the medical and surgical treatment of GERD in the last fifteen years. The proton-pump inhibitors (Prilosec, Nexium, Prevacid, Aciphex and Protonix) are potent acid-suppressing drugs which have helped many patients who were previously refractory to medical therapy. Patients with GERD who are responding poorly to medication, or who wish to avoid taking drugs, may be candidates for a surgical fundoplication. In this procedure, a portion of the stomach is wrapped around the esophagus in order to tighten the lower esophageal sphincter (the muscle responsible for preventing reflux). This procedure can now be performed through a laparoscopic, minimally-invasive approach which dramatically reduces the discomfort and recuperative time of the operation. Most patients considering surgery should undergo esophageal motility and ambulatory pH studies to determine whether the surgery is indicated and, if so, what type of operation should be performed. Three new endoscopic techniques have been approved for patients with GERD who do not want to take medications or have surgery. These techniques are performed by a gastroenterologist in the outpatient setting and are known as endoscopic suturing (EndoCinch procedure), radiofrequency wave ablation of the lower esophageal sphincter (Stretta procedure) and endoscopic plication (NDO plicator). The proper role of these procedures in the long-term management of GERD continues to be evaluated. [Top]
Achalasia
	Achalasia is an esophageal motility disorder that is characterized by the severe retention of food in the esophagus. In patients with achalasia, the esophagus loses its ability to contract in a sequential manner and the lower esophageal sphincter fails to open completely, thereby preventing the normal flow of food into the stomach. Patients with achalasia feel that food gets stuck in their throat or chest and they may experience severe regurgitation and weight loss. Achalasia results from the loss of nerve cells within the muscular wall of the esophagus. The reason for this nerve cell loss in unknown. Achalasia is treated by decreasing the lower esophageal sphincter pressure with oral medications, balloon dilation, injection of botulinum toxin (Botox) or surgery. Dr. Lambroza has counseled many patients on the appropriate treatment of their achalasia and has performed a large number of balloon dilations and Botox injections. [Top]
Eosinophilic Esophagitis
	Eosinophilic esophagitis (EE) is a chronic inflammatory disorder that is characterized by a dense infiltration of eosinophils in the wall of the esophagus. Eosinophils are white blood cells that are involved in certain allergic conditions. Patients with EE typically complain of solid food getting stuck in their throat or chest upon swallowing. Since these patients may also experience heartburn, nausea and chest pain, they are often misdiagnosed as having GERD (although the two conditions may coexist). Patients with EE experience trouble swallowing due to the esophageal strictures and rings that develop as a result of the eosinophilic infiltration. The esophageal findings of EE, which include linear furrows, multiple rings and fine white exudates, are often subtle and unrecognized at the time of endoscopy. The diagnosis of EE is made by obtaining biopsies from several locations in the esophagus and finding more than 15-20 eosinophils per high power field under the microscope. The cause of EE is thought to be an allergy to a swallowed or inhaled allergen. Therapy for eosinophilic esophagitis includes a food elimination diet, swallowed steroids (fluticasone) and/or esophageal dilation. Read Article: Eosinophilic Esophagitis by Arnon Lambroza, M.D. [Top]
Gastroparesis
	Gastroparesis is a gastric motility disorder that is characterized by delayed stomach emptying in the absence of a mechanical obstruction. The characteristic symptoms of gastroparesis include nausea, vomiting, bloating and early satiety. Abdominal pain may be a prominent symptom in some patients. The diagnosis of gastroparesis requires ruling out other causes of nausea and vomiting, such as peptic ulcer disease, gastrointestinal infection, pancreatic disease, hormonal disorders and medication side effects. The most common cause of gastroparesis is diabetes. Some patients develop gastroparesis following an episode of viral gastroenteritis. A gastric emptying study is usually performed to objectively document a delay in gastric emptying. This test involves ingesting a radiolabled meal of scrambled eggs, bread and jam and then laying under a camera which measures the length of time required for the meal to pass from the stomach into the small intestine. The treatment of gastroparesis begins with dietary management. Patients should eat smaller, more frequent meals and should avoid fatty foods, fibrous foods, red meat and fresh vegetables. Meals that are rich in protein and starches are preferred because they are more easily mixed and emptied by the stomach. Many patients require medical therapy with anti-nausea and/or pro-motility drugs. Botox injections into the pyloric sphincter of the stomach may sometimes also alleviate the symptoms of gastroparesis. The vast majority of patients with gastroparesis can be successfully managed with dietary and medical therapy. Patients with refractory nausea and vomiting who require periodic hospitalizations and/or dietary support via intravenous nutrition or direct small intestinal feeding, may be candidates for a novel therapy known as gastric electrical stimulation. This involves a device, known as Enterra (Medtronics, Inc.), which consists of a neurostimulator that is implanted in the abdominal wall, along with two wires that lead from the stimulator to the stomach. The Enterra device provides a direct electrical stimulation to the stomach and can dramatically improve symptoms of nausea and vomiting in some patients. Read Article: Gastroparesis by Arnon Lambroza, M.D. [Top]
Background
	Dr. Arnon Lambroza is a board-certified gastroenterologist and an attending physician at the New York-Presbyterian Hospital/Weill-Cornell Medical Center. He is a graduate of the Albert Einstein College of Medicine, where he was elected to Alpha Omega Alpha (AOA), the national medical honor society. Dr. Lambroza performed his internship and residency in Internal Medicine at the Hospital of the University of Pennsylvania, followed by a fellowship in Gastroenterology at the New York Hospital-Cornell Medical Center. Upon completing his fellowship, Dr. Lambroza joined the staff of the New York Hospital-Cornell Medical Center, where he was the founder and director of The Center for Esophageal and Swallowing Disorders, a unique multi-disciplinary program dedicated to treating patients with gastroesophageal reflux disease, esophageal motility disorders and difficulty swallowing. For the past 16 years he has led a monthly conference that presents cases of complex esophageal and swallowing disorders to a panel of experts in radiology, general and thoracic surgery, otolaryngology, speech pathology and rehabilitation therapy. Dr. Lambroza lectures widely on esophageal and gastrointestinal motility disorders and is the past-president of the New York Society for Gastrointestinal Endoscopy. For more information on esophageal and gastrointestinal motility disorders please contact our office. [Top]
Arnon Lambroza M.D. 950 Park Avenue New York, New York 10028 Tel: 212-517-7570 Fax: 212-517-7789