Archive April 2018 XIX, No. 4

Get Up to Speed On GERD

An update on minimally invasive treatments designed to turn down the burn of acid reflux.

Daniel Cook

Daniel Cook, Executive Editor

BIO

Heartburn
HEARTBURN HELP Patients who are dissatisfied with the effectiveness of proton pump inhibitors to control reflux are desperate for symptom relief.

Many GERD sufferers have had it up to their esophagus with the burning backwash of stomach acid. They're ready to get off Prilosec and Prevacid and get on an OR table. Are you ready for them? Laparoscopic Nissen fundoplication — which involves wrapping the upper stomach around the bottom of the esophagus to assist it in closing and prevent reflux — remains the standard surgical therapy, but several other minimally invasive treatments for gastroesophageal reflux disease are also gaining traction.

· Laparoscopic magnetic sphincter augmentation. Surgeons apply a necklace of magnetic beads made of lightweight and durable titanium around the lower esophageal sphincter. The patient's swallowing action causes the beads to separate and lets food pass; the magnets then rejoin to prevent regurgitation.

"Clinical trials, although limited, show the device is especially good at restricting reflux, which is the Achilles' heel of proton pump inhibitors," says Peter Kahrilas, MD, a professor of gastroenterology and hepatology at Northwestern University of Feinberg School of Medicine in Chicago, Ill. "Patients who have the device implanted do quite well. They're able to get off proton pump inhibitors and have shown marked reductions in regurgitation and heartburn."

The procedure came under criticism over concerns of the device eroding into the esophagus. That issue was primarily associated with a previous generation that had smaller magnetic rings and has since been taken off the market; the manufacturer of the latest magnetic sphincter augmentation device is optimistic that the issue of erosion into the esophagus has been lessened, according to Steven Schwaitzberg, MD, professor and chairman of the department of surgery at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences. Dr. Schwaitzberg, who's also the chair of the FDA's GI panel, says this treatment option has received its own CPT code and there has been movement among large commercial payers to pay for the procedure.

· Transoral fundoplication (TIF). This endoluminal plication technique employs an endoscope and proprietary device to reconstruct the angle of His — the normally acute angle between the abdominal esophagus and the fundus of the stomach at the esophagogastric junction, which is a key component of the natural anti-reflux barrier.

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