You would think that with all the proton pump inhibitors (PPIs) and other heartburn remedies on the market, that most people eventually would come upon a solution for that constant burning sensation in the chest.
But about 20 percent of people with gastroesophageal reflux disease (GERD) -- the more serious form of chronic heartburn -- never find relief with conventional medications, says Johns Hopkins Medicine. Some patients take the next step: undergoing GERD surgery, with the intent often being simply to get off of long-term medication.
The surgery, however, is invasive and not always successful. That’s why Johns Hopkins and other medical centers are taking interest in two new surgical procedures: magnetic sphincter augmentation and transoral incisionless fundoplication. The first type is in clinical trials, while the second has won FDA approval and is now in use.
Before you get the details, though, here is a beautifully simplified description of the esophagus-stomach connection and the reason for GERD, from a Johns Hopkins newsletter:
“The main reason for GERD is weak muscular tension in the gastroesophageal sphincter, which is the valve that separates the stomach from the esophagus. This valve is supposed to stay closed unless you're swallowing food or liquids. But if the muscle becomes weakened and the valve opens from time to time, stomach contents can escape upward into the esophagus, causing the familiar symptoms of GERD: heartburn and indigestion.”
As for the two above-mentioned surgeries -- as “medicalese” as they sound -- they will provide an alternative to Nissen fundoplication. In this traditional procedure, the surgeon makes a wide incision in order to reach in and wrap the upper portion of the stomach around the esophagus.
This creates pressure on the sphincter muscle and strengthens it. The Nissen fundoplication also can be done laparoscopically, but that, too, takes several hours, and either method requires general anesthesia.
Clinical trials are underway on magnetic sphincter augmentation, also known as the LINX Reflux Management System. In this less-invasive procedure, the surgeon makes a small laparoscopic incision and wraps miniature, magnetic beads around the bottom of the esophagus like a bracelet to create pressure.
Magnetic attraction keeps the beads in place, and the sphincter can still open for swallowing and belching. LINX is considered outpatient surgery.
In January 2012, an FDA advisory panel unanimously agreed that LINX has a favorable “risk-benefit profile,” partly based on a study of 100 patients who had undergone the procedure.
This uncontrolled study was one of two conducted by the manufacturer, Torax Medical Inc., on patients with chronic GERD symptoms, despite long-term acid suppression treatment performed on patients in the United States and Europe. The majority of the patients saw their GERD symptoms lessen and were able to gradually reduce their daily proton pump inhibitor dosage.
The device has been available in the United Kingdom and Germany for about two years.
On the other hand, transoral incisionless fundoplication (TIF) has been in use across the United States as an alternative to Nissen fundoplication. In this procedure, under general anesthesia, the surgeon inserts a device called the EsophyX through the throat to the stomach-esophagus junction, essentially creating a new valve. TIF can be repeated or reversed if necessary.
If your heartburn has escalated into persistent acid reflux that occurs more than twice a week, you might want to ask your health care practitioner about these less-invasive techniques.
Sources:
Alan, Rick. “Surgical Procedures for Gastroesophageal Reflux Disease (GERD)/Heartburn.” EmpowHER.com. Web. 12 March 2012. https://www.empowher.com/media/reference/surgical-procedures-gastroesophageal-reflux-disease-gerdheartburn
“FDA Panel Favors Implantable Device for Refractory GERD.” Family Practice News. Web. 12 March 2012.
http://www.familypracticenews.com/specialty-focus/digestive-disorders/single-article-page/fda-panel-favors-implantable-device-for-refractory-gerd/350ba6fe1e.html
“On the Horizon: Two New Surgical Treatments for GERD.” Johns Hopkins Health Alert. Web. 12 March 2012. http://www.johnshopkinshealthalerts.com/reports/digestive_health/3618-1.html
Reviewed March 12, 2012
by Michele Blacksberg RN
Edited by Jody Smith