As one of the first children’s hospitals to offer unsedated transnasal esophagoscopy (TNE) to diagnose and monitor eosinophilic esophagitis (EOE) in children, Riley Children’s Health provides leading-edge care for complex esophageal and GI disorders.
A commitment to using clinical expertise and advanced therapies to treat challenging conditions extends to a growing Aerodigestive Program at Riley Children’s that is now one of the largest in the Midwest. The program is led by pediatric gastroenterologist Ryan Pitman, MD, MSC, and Heather Muston, MD, a pediatric pulmonologist, at Riley Children’s. The two assumed leadership of the program in 2019, shortly after completing their respective fellowships.
“Because there’s so much interplay among medical specialties in diagnosing and treating conditions of the aerodigestive tract, having patients see multiple specialists separately is a less efficient and less patient-centric approach to care,” said Dr. Muston. “The goal of our multidisciplinary model, which we’ve purposefully designed to be more of a medical home, is to bring a more cohesive and comprehensive clinical strategy to managing these complex patients.”
In addition to pulmonology and gastroenterology specialists, the Aerodigestive Program at Riley Children’s is supported by pediatric otolaryngology, speech language pathology and professionals in nutrition and social work. New patients meet with all specialists on the first visit to develop a personalized treatment plan, with follow-up based on each patient’s needs.
Advanced technologies, including EndoFLIP
The aerodigestive team at Riley Children’s is one of the few using EndoFLIP to measure the distensibility of the esophagus to determine the cause of dysphagia. In cases in which blood vessels are pushing on the esophagus, EndoFLIP is also used to assess the extent of the collapse. The program team is also using other advanced investigation techniques, including flexible bronchoscopy with BAL and TNE.
“We have an increasing population of kids with EOE in our aerodigestive program, so we anticipate starting to use TNE more routinely in our clinic to monitor prescribed therapies and evaluate the effectiveness of treatments,” Dr. Pitman said.
Clinical research underway
In addition to managing more than 380 clinic visits in 2022—up from just 88 in 2018—aerodigestive program specialists are conducting some breakthrough clinical research. Areas of study include safety and outcomes in interarytenoid injections, head imaging in children with swallowing problems, and the use of acid blocker medicines in pediatric patients with dysphagia. A research project with a pediatric resident at Riley Children’s is examining developmental markers as a way of predicting improvement in dysphagia.
“From an anatomic perspective, we haven’t come up with a good way to predict when swallowing may improve,” Dr. Pitman said. “So we're working with developmental medicine specialists at Riley to investigate developmental factors that may predict improvement in swallowing. Findings will inform our treatment plans and help us give parents a sense of what to expect moving forward.”
The Aerodigestive Program at Riley Children’s provides multispecialty care for children with airway, lung, feeding and upper digestive tract disorders.
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