The Children's Institute Blog

Dr. Gross: Inventor of the DIEZ Method

Posted: May 11, 2017 by The Children's Institute


DIEZ is a novel, respiratory-based therapy for children and adults who do not have any disease or physical problem, but still have trouble getting food to travel through the esophagus into the stomach.

Symptoms include feeling a lump in the throat, food sticking in the throat or chest, or undigested food coming back up during or shortly after meals.

It started over 8 years ago when Dr. Gross – now a speech-language pathologist at The Children’s Institute, then working with adults at UPMC – saw an elderly woman who, had Botox injected into her Upper Esophageal Sphincter (UES) because solid food could not enter the top of her esophagus.

After the injection the woman was able to swallow food again, but surprisingly not liquids. In fact, every time she took a drink, after a few seconds, the liquid shot out of her mouth like a fountain.



Dr. Gross, knowing how the respiratory cycle influences pressures in the esophagus, told her to simply fill her lungs with air, then to exhale slowly right after swallowing. DIEZ – or dysphagia intervention for the esophageal zone – was born.

"It stayed down!” said Dr. Gross, still clearly excited by the finding. “She miraculously came back the next week and said, ‘I don’t need the therapy. I just need to do that!’”

Since coming to The Children’s Institute six years ago, Dr. Gross and colleagues have been conducting an increasing number of videofluoroscopic swallowing studies, and teaching kids who have difficulty getting or keeping down food the DIEZ technique. The Children’s Institute is a good fit for her – it’s the only place in the region that has the necessary instrumentation that measures swallowing function and breathing simultaneously.
Also, the respiratory signals can be used alone to evaluate and treat the DIEZ patients.

“The connection between breathing pressures and esophageal pressures is well-known,” Dr. Gross said. “But no one, to my knowledge, has ever exploited it for esophageal transport. We’ve been teaching kids successfully – it’s been shocking to see how quickly their symptoms go away.”

“My hope now is that we can build up the swallowing program so that more people can have access to the treatment while we work on publishing the supportive data,” she added.

Most importantly, this non-invasive technique is helping people who have not experienced relief from traditional treatments .

“I think that it is interesting that adults have said to me ’You’ll never believe it, but I’ve had this problem all of my life,’” Dr Gross said. “Now that I am seeing pediatric patients and we’re applying it to kids I believe it!”


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