Specialist in Gastroenterology
At Galen Digestive Disease Consultants our providers focus on the evaluation and treatment of disorders of the gastrointestinal tract. Our providers have an extensive understanding of the entire gastrointestinal tract, including the esophagus, stomach, small intestine, liver, gall bladder, pancreas, colon, and rectum.
Dr. Shikoh provides state of the art treatments for Crohn’s disease and Ulcerative colitis in our convenient, on-site Infusion Center located in our office on the Memorial Campus. Treatments for these chronic diseases can be accomplished in a comfortable, quiet office setting with our friendly and familiar office staff there to assist with any needs that may arise.
Patients of Galen Digestive Disease Consultants may be seen at one of several locations: Our CHI Memorial Hospital office location, Chattanooga Endoscopy Center, CHI Memorial Hospital GI outpatient lab, or our Infusion Center conveniently located in our office.
721 Glenwood Drive, Suite W473
Chattanooga, TN 37404
Every patient has different needs and require information in order to control their own health care. Whether the discussion is leading to a new diagnosis, providing support for an ongoing problem, or a review of management options, I am committed to helping make your visit specific to your needs.
Fellowship, Clinical Fellowship in Gastroenterology Vanderbilt University Medical Center
Residency, Internal Medicine
University of Virginia Health Sciences Center
Internship, Internal Medicine
University of Virginia Health Sciences Center
M.D., Vanderbilt University School of Medicine, Nashville, TN
Here at Galen Digestive Health Endoscopy, we perform thousands of endoscopic procedures each year. Our doctors, nurses, and technicians are specialty trained with over 100 years of combined experience in Endoscopy procedures. We are pleased to offer this experienced, compassionate care to every patient, every day. In fact, our reputation among the physicians in the Chattanooga area accounts for the numerous referrals we receive.
Our center has been surveyed and recognized for high-practice standards by the ASGE and AAAHC. We received the ASGE Endoscopy Unit Recognition Award for Excellence in Care. Our procedure and recovery rooms are state-of-the-art and are outfitted with the latest endoscopes and monitoring equipment for maximum visualization, accuracy, quality, and safety.
Chattanooga Endoscopy Center is proud to have 15 of the region’s premier gastroenterologists on staff. An elite group of thought leaders and prominent digestive health practitioners, the physicians that see patients at Chattanooga Endoscopy Center help make us an outstanding gastroenterology facility.
Chattanooga Endoscopy Center’s experienced, board-certified gastroenterologists are committed to ensuring the highest quality care and best outcomes for our patients. With tools such as the premier GI quality registry, GIQuIC, to track our quality measures we ensure quality care.
For this test, the doctor looks at the entire length of the colon and rectum with a colonoscope, a flexible tube about the width of a finger with a light and small video camera on the end. It’s put in through the anus and into the rectum and colon. Special instruments can be passed through the colonoscope to biopsy (sample) or remove any suspicious-looking areas such as polyps, if needed.
Before the test: Be sure your doctor knows about any medicines you are taking (including daily aspirin, vitamins, or supplements). You might need to change how you take them before the test.
The colon and rectum must be empty and clean so your doctor can see the entire inner lining during the test. There are different ways to do this, including pills, fluids, and enemas (or combinations of these). For example, you might need to drink large amounts of a liquid laxative solution the evening before the procedure. This often results in spending a lot of time in the bathroom. Because the process of cleaning out the colon and rectum is sometimes unpleasant, it can keep some people from getting this test done. However, newer kits are available to clean out the bowel and may be better tolerated than previous ones. Your health care provider can discuss the options with you.
Your health care provider will give you specific instructions. It’s important to read them carefully a few days ahead of time, since you may need to follow a special diet for at least a day before the test and to shop for supplies and laxatives. If you’re not sure about any of the instructions, call the health care provider’s office and get your questions answered.
You will probably also be told not to eat or drink anything after a certain hour the night before your test. If you normally take prescription medicines in the mornings, talk with your doctor or nurse about how to manage them for that day.
Because a sedative is used to help keep you more comfortable during the test, you will most likely need to arrange for someone you know to take you home after the test. You might need someone to help you get into your home if you are sleepy or dizzy, so many centers that do colonoscopies will not discharge people to go home in a cab or a ridesharing service. If transportation might be a problem, talk with your health care provider about the policy at your hospital or surgery center for using one of these services. There may be other resources available for getting home, depending on the situation.
During the test: The test itself usually takes about 30 minutes, but it may take longer if one or more polyps is found and removed. Before the test starts, you’ll likely be given a sedative (into a vein) to make you feel relaxed and sleepy during the procedure. For most people, this medicine makes them unable to remember the procedure afterward. You’ll wake up after the test is over, but you might not be fully awake until later in the day.
During the test, you’ll be asked to lie on your side with your knees pulled up. A drape will cover you. Your blood pressure, heart rate, and breathing rate will be monitored during and after the test.
Your doctor might insert a gloved finger into the rectum to examine it before putting in the colonoscope. The colonoscope is lubricated so it can be inserted easily into the rectum. Once in the rectum, the colonoscope is passed all the way to the beginning of the colon, called the cecum.
If you’re awake, you may feel an urge to have a bowel movement when the colonoscope is inserted or pushed further up the colon. The doctor also puts air into the colon through the colonoscope to make it easier to see the lining of the colon and use the instruments to perform the test. To ease any discomfort, it may help to breathe deeply and slowly through your mouth.
The doctor will look at the inner walls of the colon as he or she slowly removes the colonoscope. If a small polyp is found, it may be removed and then sent to a lab to check if it has any areas that have changed into cancer. This is because some small polyps may become cancer over time.
If your doctor sees a larger polyp or tumor, or anything else abnormal, a small piece of it will be removed (biopsied) through the colonoscope. It will be checked in the lab to see if it’s cancer, a benign (non-cancerous) growth, or something else.
Possible side effects and complications: The bowel preparation before the test can be unpleasant.
The test itself might be uncomfortable, but the sedative usually helps with this, and most people feel back to normal once the effects of the sedative wear off. Because air is pumped into the colon and rectum during the test, people sometimes feel bloated, have gas pains, or have cramping for a while after the test until the air passes out.
Some people may have low blood pressure or changes in heart rhythm from the sedation during the test, but these are rarely serious.
If a polyp is removed or a biopsy is done during the colonoscopy, you might notice some blood in your stool for a day or 2 after the test. Serious bleeding is uncommon, but in rare cases, bleeding might need to be treated or can even be life-threatening.
Colonoscopy is a safe procedure, but in rare cases the colonoscope can puncture the wall of the colon or rectum. This is called a perforation. Symptoms can include severe abdominal (belly) pain, nausea, and vomiting. This can be a major (or even life-threatening) complication, because it can lead to a serious abdominal (belly) infection. The hole may need to be repaired with surgery. Ask your doctor about the risk of this complication.
The American Cancer Society®
Endoscopy is a medical procedure where a doctor puts a tube-like instrument into the body to look inside. There are many types of endoscopy, each of which is designed for looking at a certain part of the body. Here we provide a brief overview of the most common types of endoscopy, including what they are used for and what to expect when you have them.
What is an endoscopy? Endoscopy (en-DAHS-kuh-pee) is a medical procedure done with an instrument called an endoscope (EN-duh-skop). The endoscope is put into the body to look inside, and is sometimes used for certain kinds of surgery.
Looking with an endoscope is different from using imaging tests, like x-rays and CT scans, which can get pictures of the inside the body without putting tools or devices into it.
There are many different kinds of endoscopes, or “scopes.” Most are like thin, hollow tubes that a doctor uses to look right into the body. Most are lighted, and some have a small video camera on the end that puts pictures on a computer screen. Endoscopes are different lengths and shapes. Some are stiff, while others are flexible. There’s a new one small enough to be swallowed, which can send images wirelessly. Each type is specially designed for looking at a certain part of the body.
Depending on the area of the body being looked at, the endoscope may be put in the mouth, anus, or urethra (your-EE-thruh) (the tube that carries urine out of the bladder). Sometimes, it’s put through a small incision (cut) made in the skin.
What is an endoscopy procedure like? There are many different types of endoscopy procedures, and the experience of having one can vary a lot from one type to the next. It’s important to keep in mind that some procedures might be done in more than one way. For example, bronchoscopy and laryngoscopy can be done with either a flexible or rigid scope. Local anesthesia (numbing the area) is generally used for flexible scopes, while rigid scopes often require general anesthesia (where you are given drugs to put you into a deep sleep).
People’s experiences may also vary depending on their health and what needs to be done, such as whether biopsy samples are going to be taken.
If you are going to have an endoscopy, your health care team will explain to you what will be done and what to expect before, during, and after the test. They will also tell you what you need to do to prepare for the procedure. The preparation could mean that you must fast (not eat anything) for a certain amount of time, follow a liquid diet for a certain amount of time, and/or use laxatives or enemas.
The American Cancer Society®
Capsule endoscopy is a procedure which uses the PillCam™, a small wireless camera shaped like a pill. The patient swallows the PillCam™, and the camera travels through the entire digestive system. As it moved through the body, the camera takes pictures of the digestive tract and sends them to a small box which the patient wears like a belt. This box saves the pictures so that the doctor can view them and spot problems in the digestive system.
The patient visits the office in the morning and swallows the PillCam™. The office staff places the recording belt in the correct position. When the patient returns the recording belt at the end of the day, staff transfer the pictures to a computer so that the doctor can analyze them.
Why is capsule endoscopy done: The capsule or pill camera allows the doctor to see parts of the digestive tract like the small intestine. The bowel is long and narrow and has many loops and turns. Typically, the capsule study looks for bleeding when a patient is losing blood for an unknown reason. Doctors also use the PillCam™ to look for changes in the lining of the small intestine due to conditions like Crohn’s disease or celiac disease.
What do I need to do to get ready: You will need to adhere to a clear liquid diet on the evening before the exam. You will also need to take a medication to clear your bowels. Take nothing by mouth for three hours before and three hours after you swallow the Pill Cam. You may take your regular medications unless your doctor advises otherwise.
What can I expect during the procedure: The capsule study is an outpatient procedure which involves swallowing the pill camera and wearing the recording belt. This test can only be done after the preparation described above has been completed. You should remain active during the test, but you must avoid strong magnetic devices such as MRI machines until after the capsule passes. Most people will pass the capsule in their stool 24-72 hours after the study. If you don’t see the capsule in your feces after 72 hours, your doctor will order an x-ray to find the capsule.
When do I get the results: Most patients discuss the results during an office visit after the procedure. After doctors review the study, they forward their findings to the provider who ordered the test. It usually takes 1-2 weeks for your physician to get the results of the test.
Are there risks with this procedure: If you have trouble swallowing, have narrowed areas in the esophagus, or suffer from severe stomach emptying delay (gastroparesis), the pill can be delivered into the small intestine with an endoscope. If your small intestine or colon has narrowed due to previous surgeries or radiation exposure, you may not be able to undergo this procedure.
Some patients with pacemaker/defibrillators need to be monitored during this test in order to prevent electrical interference with their heart devices. There is a very small risk that camera could lodge itself in the intestine. If the camera causes a blockage, you will need surgery to remove it.
When your doctor has concerns about the capsule’s ability to pass out of the digestive tract, he orders an Agile Patency Capsule. This is a replica of the pill camera made out of material that breaks down in your stomach or bowel. After you swallow this pill, it is monitored for passage in the feces. If the patency capsule gets stuck, you cannot do the actual pill camera study.
PillCam™ Small Bowel Capsule
The 24 Hour Wireless pH monitoring is a test used to evaluate for gastroesophageal reflux disease and to determine the effectiveness of medications that prevent acid reflux. This test measures the amount of acid refluxing or backing up from the stomach into the esophagus (food pipe).
Esophageal pH monitoring is used in several situations to assess for gastroesophageal reflux disease (GERD). The first is to evaluate typical symptoms of GERD such as heartburn and regurgitation that do not respond to treatment with medications. In this situation, there may be a question whether the patient has gastroesophageal reflux disease or whether antacid medications are adequate to suppress acid production. The second is when there are atypical symptoms of GERD such as chest pain, coughing, wheezing, hoarseness, sore throat. In this situation, it is not clear if the symptoms are due to gastroesophageal reflux. Occasionally, this test can be used to monitor the effectiveness of medications used to treat GERD. The test is often used as part of a pre-operative evaluation before anti-reflux surgery.
Preparation for the test: This test can be performed on or off acid suppressive therapy. Please check with your referring physician as to whether you should stop any medications prior to the study. If you are told to stop acid suppressive medications before the study then the following medications should be stopped as follows:
· Stop 7 days before the study: Prilosec (omeprazole), Nexium (esomeprazole), Aciphex (rabeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), Zegerid (immediate release omeprazole), Kapidex (dexlansoprazole).
· Stop 2 days before the study: Zantac (Randitidine), Tagamet (Cimetidine), Axid (Nizatidine), Pepcid (Famotidine).
If you were asked to obtain the study on your current regimen then do not stop any of your medications.
Do not eat or drink anything for 6 hours before the study if undergoing pH/impedance and 8 hours before the study if undergoing wireless pH monitoring.
Procedure: There are two types of pH monitoring. One might be better for you and will be decided by your doctor. Each type uses pH sensors that register the reflux of acid from the stomach into the esophagus. Combined pH/impedance monitoring also allows detection of non-acid reflux; however, it requires a catheter and a return visit in 24 hours. For each type of monitoring, you should try to perform your regular activities during the day, including the ones that may bring on your symptoms. Regular meals should be eaten during the test. Follow your doctor’s instructions regarding medication use or avoidance during the test.
The SmartPill™ motility testing system features an ingestible capsule that measures pressure, pH, transit time and temperature as it passes through the entire gastrointestinal tract. The sensor-based capsule allows for GI functional assessment with a single test and provides valuable diagnostic information, including gastric emptying time, colonic transit time, whole gut transit time and pressure patterns from the antrum and duodenum.
The SmartPill™ motility testing system calculates colonic transit time for the evaluation of colonic transit in patients with chronic constipation and differentiation of slow and normal transit constipation. The system also measures combined small and large bowel transit time, which is used as a surrogate measure of colonic transit in patients with chronic constipation when colonic transit time alone cannot be determined.
· The only motility test that provides a complete transit profile of the gastrointestinal tract
· Increased sensitivity compared to Gastric Emptying Scintigraphy (GES) and Radio Opaque Markers (ROM)1
· Ability to localize disease to specific regions of the GI tract in the presence of overlapping motility symptoms2
· Standardized motility testing process with benchmarked results1
The SmartPill™ motility testing system localizes abnormalities in specific areas of the GI tract in the presence of overlapping motility symptoms. This advanced system allows you to understand the root cause of your patients’ motility disorders and helps you develop appropriate therapy plans. With user-friendly SmartPill™ software, analyzing study results is simple and convenient.
The SmartPill™ motility capsule detected a generalized motility disorder in 51% of patients and influenced management in 30% of patients with lower GI disorders and 88% of patients with upper GI disorders.
· Reduces testing by replacing three tests3
· Whole gut motility profile eliminates the need for segmental transit studies3
· Can replace GES, ROM, and Whole Gut Scintigraphy3
· Can reduce the cost of separate procedures and associated facility fees by 50%
1. Kuo, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2008;27:186-196.
2. Rao, et al. Evaluation of gastrointestinal transit in clinical practice: Position paper of the American and European Neurogastroenterology and Motility Societies. Neurogastroenterol Motil. 2011;23(1):8-23.
3. Moshiree B. Case Presentation Illustrating Use of Wireless Motility Capsule. 2010 Joint International Neurogastroenterology and Motility Conference.
Esophageal manometry is a test used to measure the function of the lower esophageal sphincter (the valve that prevents reflux of gastric acid into the esophagus) and the muscles of the esophagus (see diagram). This test will tell your doctor if your esophagus is able to move food to your stomach normally. To know why you might be experiencing a problem with your digestive system, it helps to understand the swallowing and digestive processes.
The manometry test is commonly given to people who have:
· Difficulty swallowing
· Pain when swallowing
· Chest pain
The swallowing and digestive processes
When you swallow, food moves down your esophagus and into your stomach with the assistance of a wave-like motion called peristalsis. Disruptions in this wave-like motion may cause chest pain or problems with swallowing.
In addition, the muscular valve connecting the esophagus with the stomach, called the esophageal sphincter, prevents food and acid from backing up out of the stomach into the esophagus. If this valve does not work properly, food and stomach acids can enter the esophagus and cause a condition called gastroesophageal reflux disease (GERD).
Manometry will indicate not only how well the esophagus is able to move food down the esophagus but also how well the esophageal sphincter is working to prevent reflux.
Cleveland Clinic Health Library 2017
What is infusion therapy: administering medication using a sterile catheter that is inserted into a vein and secured. This treatment method has traditionally been used only in hospitals, but now infusion therapy can be administered in outpatient infusion therapy centers, or even in your home by specially trained nurses. These nurses have been licensed by the state board of pharmacies, meeting the strict standards and regulations set by the board and by the government.
What does Infusion Therapy treat: Infusion therapy is usually employed to treat serious or chronic infections that do not respond to oral antibiotics. Cancers and the pain caused by cancers; diseases of the gastrointestinal tract; dehydration caused by nausea, vomiting and diarrhea; and other serious diseases, such as Crohn’s disease, are typical examples. Additional complex illnesses that respond best to intravenous medications include: multiple sclerosis, some forms of arthritis, congestive heart failure and some types of immune deficiency disorders. Certain congenital diseases require intravenous medications as well.
Avella offers clinical expertise in meeting the unique needs of our patients using infusion therapies as part of their medication treatment plan. Our pharmacy team can collaborate with your doctor to monitor your therapy while helping you manage side effects and avoid drug interactions. While we know the process of taking your medications by infusion therapy is not easy, Avella is dedicated to making the process of managing your condition through medication as simple as possible. Infusion therapy shouldn’t be uncomfortable or frightening. Leave it to the experts.
Some examples of infusion therapies include:
What is a Gastrostomy feeding tube: A feeding tube is a device that’s inserted into your stomach through your abdomen. It’s used to supply nutrition when you have trouble eating. Feeding tube insertion is also called percutaneous endoscopic gastrostomy (PEG), esophagogastroduodenoscopy (EGD), and G-tube insertion.
This treatment is reserved for when you have trouble eating on your own, due to reasons such as the following:
· You have an abnormality of your mouth or esophagus, which is the tube that connects your throat to your stomach.
· You have difficulty swallowing or keeping food down.
· You aren’t getting enough nutrition or fluids by mouth.
Conditions that can cause you to have trouble eating include:
· cerebral palsy
· motor neuron disease
The treatment can also be done if you need it to receive certain medications.
Do I need to prepare for the procedure: . Before you begin, tell your physician about any medications you’re taking, including blood thinners such as warfarin (Coumadin), aspirin (Bufferin), or clopidogrel (Plavix). You’ll need to stop taking blood thinners or anti-inflammatory medications one week or so before the procedure.
Your doctor will also need to know if you’re pregnant or have certain conditions, such as:
· heart conditions
· lung conditions
If you have diabetes, your oral medications or insulin may have to be adjusted the day of the procedure. Your doctor performs a gastrostomy using an endoscope, which is a flexible tube with a camera attached. You may be given anesthesia to make you more comfortable. This may make you drowsy following the procedure. Before the procedure, arrange to have someone drive you home.
This procedure requires you to fast. Typically, doctors ask that you abstain from eating eight hours before the procedure. Most people can return home the same day as the procedure or the following day.
How is the endoscope inserted: Before the procedure, you need to remove any jewelry or dentures. You’re then given an anesthetic and something to relieve pain. While you’re lying on your back, your doctor places the endoscope in your mouth and down your esophagus. The camera helps the doctor visualize your stomach lining to ensure that the feeding tube is positioned properly.
When your physician can see your stomach, they make a small incision in your abdomen. Next, they insert the feeding tube through the opening. They then secure the tube and place a sterile dressing around the site. There may be a little drainage of bodily fluids, such as blood or pus, from the wound. The whole procedure usually lasts less than an hour. The feeding tube can be temporary or permanent, depending on the primary reason for the feeding tube.
After the procedure: Plan on resting after the procedure. Your abdomen should heal in about five to seven days. After the tube is inserted, you may meet with a dietitian who will show you how to use the tube for feeding. Your dietitian will also educate you on how to care for the tube. Drainage around the tube is normal for a day or two, and a nurse will probably change your dressing on a regular basis. Feeling pain for a few days around the place where the incision was made is normal. Make sure to keep the area dry and clean to avoid skin irritation or infection.