Esophagus and Reflux Center (CER): new specialized center opens at IRCCS Policlinico San Donato

The Center specifically manages patients with:

• gastroesophageal reflux disease;
• hiatal hernia;
• esophageal motility disorders such as achalasia;
• esophageal diverticula;
• swallowing difficulties (dysphagia).

Alongside these conditions, the Center also manages more complex cases, such as esophageal strictures or perforations and complications that may arise after endoscopic or surgical procedures.

Symptoms not to underestimate

Many people suffering from gastroesophageal disorders do not yet have a diagnosis but have been living for a long time with symptoms that affect their quality of life.

Symptoms that may signal an esophageal or gastric disorder include:

• burning behind the breastbone or chest;
• regurgitation of food or liquids;
• difficulty or pain when swallowing;
• sensation of blockage in the throat or chest;
• persistent cough with no apparent cause;
• hoarseness or voice changes (dysphonia);
• non-cardiac chest pain;
• bloating and recurrent digestive disorders;
• meal-related arrhythmias.

Some of these symptoms are very common and tend to be underestimated or treated non-specifically for years.

Others, such as dysphonia or digestion-related arrhythmias, require a multidisciplinary approach, involving specialists such as ENT doctors, cardiologists, and pulmonologists, all of whom are available through the CER Center at Policlinico San Donato.

The Esophagus and Reflux Center has been designed to offer patients comprehensive management, from the first specialist consultation through to treatment.

Specialist consultation

The diagnostic pathway always begins with a dedicated specialist consultation with the general surgeon, during which the physician:

• collects the patient’s medical history;
• analyzes the reported symptoms;
• identifies any risk factors.

Instrumental tests and advanced diagnostic technologies

Based on the clinical evaluation, the specialist may recommend targeted instrumental tests, which are essential for an accurate diagnosis, including:

• digestive endoscopy;
• high-resolution esophageal manometry;
• pH-impedance monitoring;
• abdominal ultrasound.

These investigations make it possible to thoroughly assess the cause of symptoms and identify the most appropriate treatment.

The Center also uses advanced diagnostic technologies, including EndoFLIP, a tool that allows highly precise assessment of the function of the junction between the esophagus and the stomach, which is particularly useful in guiding therapeutic decisions in more complex cases.

The One Day Clinic pathway: multiple tests in a single day

One of CER’s distinctive features is the One Day Clinic pathway, designed for patients who need to undergo multiple investigations.

This organizational model makes it possible to concentrate several tests into a single day, with the option of performing procedures under assisted deep sedation, reducing waiting times and discomfort for the patient.

“Our goal is to make the diagnostic pathway as simple and fast as possible. When a person has been living for a long time with symptoms that limit daily life, obtaining a clear diagnosis quickly is essential,” Prof. Asti emphasizes.

The Barrett’s esophagus pathway

In the field of cancer prevention, the Center also offers genetic testing for the evaluation of Barrett’s esophagus, a condition that requires regular monitoring over time.

Thanks to advanced molecular analysis techniques, available in only a few centers worldwide, it is possible to assess individual risk more precisely and personalize the follow-up program.

“Today, technology allows us to see things that were invisible until a few years ago. With tools such as EndoFLIP and molecular analyses for Barrett’s esophagus, we can make much more precise decisions and reduce the margin of error in patient management.”

Once the diagnostic phase has been completed, the Center’s team defines a personalized therapeutic pathway, tailored to each patient on the basis of the condition, symptoms, and individual clinical history.

The Center offers all currently available treatment options:

• minimally invasive surgery;
• medical therapies;
• endoscopic treatments.

In many cases, treatment can be carried out with medication or endoscopic procedures, allowing certain conditions to be treated directly from within the esophagus, avoiding more invasive surgery.

When the disease is more advanced or complex, surgery may become necessary.

In these cases, the Center’s team carefully evaluates the most appropriate pathway to identify the safest and most effective therapeutic solution.

At IRCCS Policlinico San Donato, minimally invasive techniques such as laparoscopy and robotic surgery are also performed, helping to reduce the impact of surgery on the patient and support faster recovery.

“Every patient is unique; our goal is to find the treatment that best suits each individual, perfectly in line with the concept of personalized medicine.”