In 2021, the Division of Digestive and Liver Diseases at NewYork-Presbyterian/
Dr. David Katzka
“Starting this center at Columbia meets a very important clinical need for the New York region,” says Dr. Katzka, who specializes in eosinophilic esophagitis, esophageal motility disorders, gastroesophageal reflux, Barrett's esophagus, and unusual esophageal diseases. “As a comprehensive program, the Esophagology and Swallowing Center draws on the expertise of a range of specialists who care for patients with esophageal disease – surgeons, radiologists, pediatric gastroenterologists, pathologists, as well as speech pathologists.”
Dr. Katzka points to the increasing number of upper GI diseases in recent years that warrant greater attention at earlier stages, one of the main goals of the new center. “Reflux is one of the most rapidly rising diseases within the past 30 years, along with adenocarcinoma of the esophagus related to reflux that has risen exponentially over the past several decades,” he says. “What was once a fairly unusual tumor has now unfortunately become the fourth most common gastrointestinal tumor in the U.S. It is also one that has a severely poor prognosis because most patients present in advanced stages. An esophageal center that helps to identify patients early on with reflux or with signs of high risk for developing adenocarcinoma of the esophagus is essential for patients.”
Eosinophilic Esophagitis: Advances for an Emerging Disease
Eosinophilic esophagitis (EoE) is another once rare disease that is the focus of much of Dr. Katzka’s efforts in research and treatment. Part food allergy and part swallowing disorder marked by scarring and narrowing of the esophagus, today EoE has become a common and debilitating disease that affects both children and adults. “In 2007, eosinophilic esophagitis was a rare disease with limited clinical data available describing the symptoms, demographic characteristics, and endoscopic findings,” says Dr. Katzka. “Treatment has generally been topical steroids and diet exclusion therapy. Today, the molecular, genetic, and evolving microbiome’s contributions to EoE are being explained. It is one of the most common diseases seen in our practice, and we offer rigorously performed controlled trials of steroids and biologics, including FDA-approved dupilumab. Identification of a single food antigen as the cause in 40 percent of patients with EoE has also made dietary interventions easier to plan.”
A prolific researcher, Dr. Katzka has greatly influenced progress in the field, with more than 350 publications to his name. He also participated in a five-year role for the Consortium of Eosinophilic Gastrointestinal Disease Researchers-Clinical Trial 2: Six Food versus One Food Eosinophilic Esophagitis Elimination Diet (SOFEED) followed by Swallowed Glucocorticoid Trial.
According to Dr. Katzka, there remains a pressing need for a reliable and less invasive test than endoscopy to assess and monitor treatment for EoE. To that end, he collaborated with former colleagues at the Mayo Clinic in testing an esophageal sponge developed in the United Kingdom for the identification of antigen triggers and in directing dietary elimination treatment. The device consists of an ingestible gelatin capsule containing a compressed mesh sponge attached to a string. The patient swallows the capsule and once in the stomach the mesh is released. Five minutes later the mesh is withdrawn through the mouth obtaining an esophageal tissue specimen.
“The esophageal sponge obviates the need for endoscopy and anesthesia, presenting a much lower risk to the patient,” says Dr. Katzka. “It is also becoming one of the most important ways for screening for esophageal cancer. Columbia is perhaps one of only two centers in the country offering the sponge for esophageal cancer screening and monitoring patients with eosinophilic esophagitis.”
“There are certain foods that clearly trigger this disease, but sometimes it is very hard to identify those foods,” continues Dr. Katzka. “We know that the delay in diagnosis is on average two to seven years after the onset of symptoms. This tells us there are still many physicians who aren’t thinking about this diagnosis, or a lot of patients don’t seek a doctor’s attention at a much earlier stage of the disease.”
Dr. Katzka emphasizes that physicians should observe a patient’s subtle symptoms of trouble swallowing and what they do to avoid the problem. “For example, patients with EoE will often chew a lot more than normal people. They’ll drink a lot more fluid during their meal than others. They will eat much more slowly. These become the habits they just live with. As a result, all of these maneuvers that make it easier for the food to pass mask the disease and allow it to become more severe than if it had been recognized earlier. It’s not curable in the sense that we think there are genetic components to this disease, but it’s definitely manageable. Patients need careful follow-up and monitoring.”
Dr. Katzka has developed an esophageal motility test – esophageal transit scan – in collaboration with colleagues in nuclear medicine. “As opposed to an esophagram that involves drinking barium, this test uses real food,” says Dr. Katzka. “Sometimes the esophagus may not display problems with liquids, but it does show problems with solids. This scan, which is available in very few places in the country, serves as an adjunct test to further explain why patients have trouble swallowing.”
Esophageal Atresia: A Focus on Transition of Care
Esophageal atresia, with or without trachea-esophageal fistula, is the most common congenital anomaly of the esophagus occurring in 1 in 2,500 to 4,000 live births. A fatal disease before the development of surgical correction, today most patients live to adulthood. However, the effects of the anomaly may lead to a lifetime of complications that can include atonicity of the esophageal segment, fistula recurrence, and esophageal cancer, as well as problems related to the surgery, including anastomotic stricture, gastroesophageal reflux, and coping with an organ transposition.
“Esophageal atresia represents another important component of the Esophagology and Swallowing Center with an emphasis on transition of care,” says Dr. Katzka. “We’re working closely with Columbia pediatric gastroenterologists and surgeons to ensure that a smooth and effective transition for patients is made through their teenage years and into adulthood. We know that without such a program, we often lose these patients to follow-up.”
Dr. Katzka and colleagues in Columbia’s Divisions of Pediatric Gastroenterology, Hepatology, and Nutrition, Pediatric Surgery, and Adult Gastroenterology recently completed a study of esophageal atresia in adults. Their review, which was published in the August 9, 2022, issue of Clinical Gastroenterology and Hepatology, examines the occurrence and management of chronic complications in later life and the role of an effective transition from pediatric to adult care to optimize treatment.
Looking to the future, Dr. Katzka has outlined three immediate goals for the Esophagology and Swallowing Center. “We want to identify esophageal cancer in patients in its earliest, therefore, treatable stages; offer the best care we can for lifelong treatment for patients with eosinophilic esophagitis; and build an effective child-to-adult transition program for esophageal diseases,” says Dr. Katzka. “Here at Columbia we have the resources and the expertise in the full range of esophageal diseases and disorders to optimize outcomes and provide an improved quality of life for our patients.”