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  • Which Direction to Turn with GERD

    Which Direction to Turn with GERD – An Endoscopic Treatment Primer

    August 28, 2006

    By: Jean Johnson for Reflux1

    Most people are familiar with medications and surgery focused on relieving symptoms associated with GERD. They tend to be less familiar, however, with the newer minimally invasive endoscopic procedures. But these approaches to treating reflux are proving to be remarkably successful in restoring function to those who suffer – and are a way to approach treatment that does not require surgery. Also, patients are often able to abandon reliance on medications after treatment.
    Take Action
    Are you at risk for acid reflux? The following conditions place you at increased risk:
  • Obesity
  • Hiatal hernia
  • Pregnancy
  • Asthma
  • Diabetes
  • Peptic ulcer
  • Delayed stomach emptying
  • Connective tissue disorder
  • Zollinger-Ellison syndrome

  • Consequently, in the interest of spreading the word, this article will summarize the endoscopic treatments that are available. With this in hand, the next time you or a loved one sees their gastroenterologist or physician, they will have sufficient background from which to have an educated discussion about their candidacy for a minimally-invasive treatment option.

    Acid Reflux Anatomy and Physiology – A Short Lesson

    One of the dimensions to consider with reflux is that the stomach is truly a cauldron full of pretty scary stuff. Given all the two liter bottles of soda on the store shelves, most of us can envision what two liters of liquid looks like. Translate that into how much strong stomach acid the body can produce each day to digest food. Add into the equation a lower esophageal sphincter that’s gotten a little on the flabby side and doesn’t close all that well any more – and there you have it. A picture of what physicians are up against when they try to help patients with gastroesophageal reflux disease (GERD) – or as it’s often termed acid reflux.

    While many people experience occasional bouts of heartburn – 40 percent of Americans have heartburn once a week – it’s when episodes increase to several times a week or even wake a person up at night that thing have progressed to where a person needs to talk to a physician and perhaps consider seeing a gastroenterologist for treatment. It’s the same for people whose heartburn returns once the antacid they take wears off, since this is yet another sign that it’s time for more intensive medical treatments. Similarly, if prescription medicines no longer control the symptoms, there is trouble swallowing or weight loss, it’s a heads up to get in to see the pros and face the music.
    Take Action
    Self-care tips to help with heartburn:
  • Control your weight
  • Eat smaller meals
  • Loosen your belt
  • Eliminate heartburn trigger foods from your diet
  • Avoid stooping or bending for long periods of time
  • Don’t lay down immediately following a meal
  • Raise the head of your bed
  • Don’t smoke

  • As Peter Mavrelis, M.D., gastroenterologist in practice for 25 years observed, reflux is chronic, so unless something changes with the physiology, people will continue having the problem throughout their life. Also, while lifestyle changes including losing weight if a person is overweight or obese, avoiding night eating, stopping smoking and avoiding alcohol can help decrease the symptoms of reflux, Mavrelis’ experience is that it is very difficult for people to change their habits.

    He added, though, that GERD is common and people of all ages can get it, but that “it’s easily treated with various procedures or medications.” Mavrelis also notes that a relatively low number of patients can develop chronic inflammation of the esophagus known as Barrett’s esophagus which can lead to cancer. Thus, he urges patients to get help and have problems treated before they potentially lead to serious medical conditions.

    Stretta System

    The Stretta System is non-invasive like all endoscopic treatments – meaning no incision is made in the body – and uses radiofrequency energy to restore lower esophageal sphincter function. Essentially the gastroenterologist trained in this procedure inserts an endoscope down into a sedated patient’s esophagus and radiofrequency waves are delivered via small, antennae-like electrodes to the lower esophageal sphincter. Post procedure, the treated sphincter will become stronger and will function normally as a barrier to keep acids in the stomach where they belong.

    Stretta is good for patients who do not respond to medication or who want to stop taking expensive medications. It does not require an incision like surgery does, and thus patients do not need general anesthesia for the out-patient treatment which usually runs around a half hour. Most resume normal activities by the following day. There is a transition period after the procedure of several weeks to months while the scar tissue is accumulating sufficiently to disrupt the reflux process. Other than that, the only side effects that have been reported include some sore throat and chest pain for a short time after the procedure.

    Bard Endocinch System

    Endocinch works pretty much just like the name sounds. Again this is a minimally-invasive procedure accomplished with an endoscope. The gastroenterologist places sutures in the top of the stomach that cinch the area in smaller. That way less pressure is exerted on the lower esophageal sphincter, and patients with reflux get relief from their symptoms.

    With this approach to treatment, symptoms often lessen within days. Consequently patients that relied on medications can lessen if not stop their dependence on these drugs. Commonly reported side effects include sore throat as well as nausea that may include vomiting.

    Plicator System

    To plicate means fold in the form of a fan, so gastroenterologists who take this approach for treating patients use a pre-tied implant designed to fold the lower esophageal sphincter into a fan-like affair, thus tightening the opening. As with all of the endoscopic approaches, the Plicator procedure takes around a half hour and is done on an out-patient basis.

    And as with Stretta and Endocinch, recovery from the plication is rapid with the effects of the light sedation required for endoscopic work wearing off within the day and only some minor, temporary chest pain. Finally, the Plicator procedure has been shown to provide significant relief from heartburn caused by reflux.

    So Many Choices

    As far as which procedure is best – or if an endoscopic option is the best approach for treating the type of GERD a particular patient has – only gastroenterologists trained in the field can make those types of decisions. Patients, though, are well advised to know their options and also understand that specialists tend to work only in one type of treatment or related treatments. Consequently, often getting second opinions helps reassure the person who is suffering that the advice they are getting is the best and most current available.

    Are you interested in finding a physician to discuss a minimally-invasive treatment for your reflux? Click here to start your search.

    Last updated: 28-Aug-06


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