Resume of A.A. Starpoli, MD

ANTHONY A. STARPOLI, MD
29 Washington Square West
New York, New York 10011
Telephone: (212) 673-2721

EDUCATION

A.B., Biology
May 1981 Vassar College Poughkeepsie, New York
Doctorate of Medicine, June 1986 University of Illinois College of Medicine Chicago, Illinois

CLINICAL

Internship
Internal Medicine, July1986 - June 1987 Sound Shore Medical Center New Rochelle, NY
University Hospital of New York Medical College

Residency, Internal Medicine
June1987 - June 1989
Chief Resident, July 1988 - June 1989 Greenwich Hospital
& Yale University School of Medicine Greenwich, Connecticut

Fellowship, Gastroenterology
July 1989 - June 1991 St. Vincents Catholic Medical Center
University Hospital of New York Medical College New York, New York

Attending, Gastroenterology and Internal Medicine
July 1991 to May 2010 Director of Gastroesophageal Research and Endosurgery, St. Vincents Catholic Medical Center, University Hospital of New York Medical College New York, NY May 2004 Lenox Hill Hospital New York, NY
June 2010 Beth Israel Medical Center New York, NY
July 2010 New York University Medical Center New York, NY

Clinical Assistant Professor of Medicine
July 1994 to present
New York Medical College Valhalla, New York

BOARD CERTIFICATION

Diplomate American Board of Internal Medicine 9.13.1989
Subspecialty Board Certification in Gastroenterology 11.5.1991

LICENSURE

New York # 173431
Connecticut # 029786 (inactive)
California # G 74229

CERTIFICATES

EndoCinch (Endoluminal Gastroplication) Procedure April 2000,NDO Fundoplicator July 2004

SOCIETIES AND MEMBERSHIPS

American Gastroenterological Association, American Society of Gastrointestinal Endoscopy, American College of Gastroenterology, Society of American Gastrointestinal Endoscopic Surgeons New York Society for Gastrointestinal Endoscopy, American College of Physicians, Medical Society of the State of New York, Dutchess County Medical Society, American Motility Society

Everyone occasionally has heartburn. This occurs when stomach acid flows backward into the esophagus, the food pipe that carries food to the stomach. People usually experience heartburn after meals as a burning sensation or pain behind the breast bone. Often, regurgitation of food and bitter-tasting stomach acid accompanies heartburn. Antacids or milk temporarily relieves heartburn for most people.

Why Does Heartburn Occur?
To understand heartburn, let us look at the body's anatomy. The esophagus carries food and liquid to the stomach. A sphincter, or muscular valve, is located at the end of the esophagus at the border between the esophagus and stomach. Known as the lower esophageal sphincter (LES) this muscle contracts much the same as the anus does. The sphincter should maintain a certain pressure to keep the end of the esophagus closed so that stomach juices are not admitted. The LES muscle should only open when food is passed into the stomach.

However, the LES muscle does not always work perfectly. It is felt that the problem is with inappropriate, transient relaxations of this sphincter valve that result in reflux. Sphincter function can be easily overcome by a number of factors, the most common being eating a large meal. Along with swallowed air, a large meal causes an upward pressure in the stomach to rise, thereby overpowering the LES muscle. Other factors that reduce the LES pressure and allow reflux are:

• Nicotine (cigarettes)
• Fried or fatty foods
• Chocolate
• Coffee
• Citrus fruits and juices
• Peppermint
• Pregnancy
• Lying flat
• Hiatus hernia
• Certain prescription medications

Swallowing difficulty, medically termed dysphagia, can arise for a variety of reasons.  Firstly, reflux alone can disturb the muscular contraction or motility of the esophagus and interfere with the passage of liquids and solids.  Often, when reflux is controlled, these symptoms will disappear.

The inflammatory response of the esophagus from chronic reflux can lead to the formation of a ring of scar tissue at the end of the esophagus where it meets the stomach, an area know as the gastroesophageal junction (the location of the LES), that can lead to a mechanical obstruction causing difficultywith swallowing solids.  This entity is known as an esophageal ring or a Schatzki Ring.  In some cases the ring needs to be disrupted in order to resolve the blockage.

Of course with chronic reflux comes the risk of esophageal cancer and although the risk is low, it is very real.  Such tumors can cause significant blockage and bleeding.  The cancers are diagnosed most often by way of video upper endoscopy.  A person presenting with new-onset swallowing trouble, a history of reflux, bleeding, and weight loss should seek a medical evaluation immediately.

There are a variety of primary esophageal motility disorders that cause swallowing trouble.  Achalasia is a disorder that can be quite insidious and involves that loss of motility in the body of the esophagus and the lower esophageal sphincter (LES)fails to relax.  The physical presentation can look like reflux because the patient does not clear contents of the esophagus and those materials can backwash into the upper esophagus and mimic GERD. The diagnosis of Achalasia is made by way of esophageal manometry whereby the wave forms  of the esophagus are measured to make the diagnosis.  Achalasia can be treated surgically (laparoscopically) or by balloon dilation of the lower sphincter.

There are other esophageal motility disorders that can be described by esophageal manometry and they include diffuse esophageal spasm that is often associated wit noncardiac chest pain, the Nutcracker esophagus, and Ineffective Esophageal Motility.  Esophageal motility studies ( manometry) will require the passage of a small caliber tube into the esophagus through a nasal passage.  The test takes about 20-30 minutes to complete and is well-tolerated.  It is performed as an out-patient.