Next time you have a meal, just stop and ponder for a minute.
You take a bite, chew and swallow. You feel the food move down your throat, then seemingly disappear. What happens next?
Without conscious effort, the food continues to make its way towards your stomach, while you go for your next bite.
But what happens if this seemingly simple process goes wrong?
You need an expert. An expert like Dr Jennifer Myers.
A tube for transporting food
Based at The Queen Elizabeth Hospital (TQEH), Dr Myers is a specialist clinical scientist who works in a field primarily focused on one organ: the oesophagus (pronounced ee-so-fah-gus).
“The oesophagus is the muscular tube that joins the back of your throat to your stomach,” Dr Myers says.
“In my role, I use specialised equipment to assess whether the oesophagus and the valve at the top of the stomach are working properly.”
There are two main reasons healthcare providers typically send patients to be clinically assessed by Dr Myers: when swallowing doesn’t send food down the oesophagus as normal, and unresolved, persistent reflux.
Although it’s often referred to as heartburn, reflux happens when stomach contents leak into the oesophagus.
Reflux occurs when stomach contents leak from the stomach into the oesophagus. This can cause short- and long-term damage, as well as symptoms like heartburn (discomfort or a burning sensation in the chest area), regurgitation and difficulty swallowing.
“Most often, doctors will guide patients to explore lifestyle changes, medications and simple ways of improving swallowing problems or troublesome reflux,” Dr Myers says.
“But when the nature of the problem is unclear or there’s no improvement in symptoms, that’s where the assessments I undertake can be useful.”
The Oesophageal Function clinic at TQEH is one of three similar services available to adults in South Australia.
Other clinical scientists working across CALHN provide functional assessments of lungs, heart, brain, blood flow and sleep.
How does the oesophagus work?
At the top and bottom of the oesophagus are muscle segments which act as valves. Most of the time, these valves are closed.
When you swallow, the top valve opens to let food or drink pass into the oesophagus. Next, nerves in that region trigger a muscle action called peristalsis. This acts like a co-ordinated series of squeezing movements down the oesophagus towards the stomach – like a conveyer belt, propelling downwards what is swallowed.
When food or drink reaches the bottom of the oesophagus, nerves tell the valve at the bottom to relax and open. Acid and digestive juices in the stomach can then start the process of digestion.
Organs of the digestive system. Image thanks to anatomytool.org/
24-hour monitoring of reflux
When reflux occurs, getting a good handle on what’s going on inside the oesophagus requires more than just a snapshot.
Patterns of pressure inside the oesophagus reflect how well the muscles are working, and whether the valves at the top and bottom are behaving normally. Changes in acidity within the oesophagus are an indication of back-flow of stomach acid.
“Typically, I set up monitoring for measurements of stomach reflux into the oesophagus over a 24-hour period,” Dr Myers says.
“To do so involves gently inserting a string-like tube through the nose and into the oesophagus, and leaving it in place during the monitoring period.”
The tube is thin enough to allow a patient to continue to eat, drink and do normal daily activities. Sensors in the thin tube enable collection of reflux data that Dr Myers analyses and interprets as part of the assessment.
Finding solutions for patients
Working closely with clinic medical staff, Dr Myers analyses and interprets collected data to give the referring doctor a better sense of what is going on inside the patient’s oesophagus.
“Then the patient can be informed about how their oesophagus is working and be offered some options for better management of their symptoms, whether that’s a form of surgery or medication,” says Dr Myers.
Dr Myers is also involved in research to improve knowledge of oesophageal function, as well as education and training of medical students and doctors, both nationally and internationally.
If you or someone you know is experiencing persistent reflux or another unexplained problem with swallowing, talk with your doctor about whether your invisible, tricky to spell, but very important oesophagus might be involved.
About the scientist
Dr Jennifer Myers, PhD, is a Clinical Medical Scientist in Oesophageal Function at CALHN, and a member of the Oesophageal Physiology Group at the Basil Hetzel Institute for Translational Health Research. She is a Senior Lecturer and member of the research team in The University of Adelaide Department of Surgery.
Dr Myers was awarded CALHN’s Medical Scientific and Medical Physicist Excellence Award in 2024.
