TOWSON, Md. (Ivanhoe Newswire) -- Acid reflux disease, a condition commonly known as "GERD", affects about one-third of Americans. It can cause pain, coughing, heartburn and can even lead to cancer. Now, a simple procedure may fix GERD for good.
For 12 years, Kathy Dickinson lived with the painful symptoms of GERD. GERD happens when the lower esophageal sphincter weakens and allows food to flow up. For Dickinson, it meant coughing, pain and no sleep.
"It would happen in the morning. It would happen after I ate. It would happen at night, it was, and it just progressively got worse and worse and worse." She told Ivanhoe.
Dr. Mark Noar of the Endoscopic Microsurgery Associates in Townson, Md. told her about a procedure to fix GERD for good. It's called the Stretta procedure. Patients are sedated while doctors insert a catheter down the throat and deliver radiofrequency energy to stimulate tissue and strengthen muscles.
"The sphincter muscle gets thicker and stronger, so it won't open as easily." Dr. Noar told Ivanhoe.
In a recent study, researchers found 72 percent of patients no longer had reflux 10 years after the procedure and 41 percent were off medications.
Bob Davis had the Stretta procedure and is glad he did. "I reduced my medicine by three pills a day!" Davis told Ivanhoe.
Dickinson had it too and no longer has the symptoms of GERD. "It's something that's not a part of my life anymore." She said.
The study also found 85 percent of those with Barrett's esophagus, a pre-cancerous condition that can develop in GERD patients, no longer had the condition 10 years after having the Stretta procedure. None of the patients studied developed esophageal cancer. Dr. Noar says this could mean the procedure protects against cancer, but more research is needed to confirm that finding.
BACKGROUND: Gastroesophageal reflux disease (GERD) is a chronic disease in the digestive system and occurs when stomach acid flows back up into the esophagus. This backwash damages the esophagus and that causes GERD. The severity of GERD usually depends on the type and amount of backwash and acids come up from the stomach and how the body uses saliva to neutralize it. GERD gives your esophagus a burning feeling and causes coughing and pain. (Source: http://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1)
CAUSES: Dietary choices are often linked to the cause of GERD. Foods like chocolate, peppermint and fried and fatty foods can trigger reflux. The primary cause of GERD stems from the dysfunction of the lower esophageal sphincter (LES). The LES is a circular muscle that runs around the bottom of the esophagus and works as a valve that loosens to allow food and liquid down into your stomach. If this valve doesn't function normally, stomach acids can then flow back up into the esophagus and irritate the lining. (Source: http://www.mayoclinic.org/diseases-conditions/gerd/basics/causes/con-20025201)
TREATMENT: There are many options for the treatment of GERD. Some lifestyle changes that doctors may recommend include wearing loose-fitting clothing, losing weight and keeping yourself upright for three hours after each meal. There are also over-the-counter medications that can help reduce the symptoms of GERD like antacids and H2 blockers. In extreme cases of GERD, surgery can be used but brings a much higher risk of developing complications. (Source: http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/#treatment)
NEW TECHNOLOGY: A new procedure called the Stretta procedure is being done to eliminate the symptoms of GERD and improve the life of those living with the disorder. The Stretta procedure involves radiofrequencies delivered to the lining of the throat through a disposable catheter that is slid down the throat while the patient is sedated. The RF waves work to stimulate the muscles of the LES and make it stronger. A stronger LES functions better and in turn reduces the symptoms of GERD. The entire procedure only takes around 40 minutes to an hour and doesn't require the patient to stay in the hospital. Results of the Stretta procedure have proven it to be safe and have shown significant reduction of the effects of GERD in two-thirds of the patients tested. (Source: http://www.healthline.com/health/gerd/stretta-procedure)
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Audra B. Friis
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Mark Noar, M.D., Gastroenterologist at Endoscopic Microsurgery Associates and Director of the Heartburn and Reflux Center, Towson, Maryland.
Can you explain to me what GERD is and how many people are affected by it?
Dr. Noar: Gastroesophageal reflux disease is probably the most common disease in gastroenterology. It affects approximately 50 to 60 million people, most of which are taking some form of medication on a daily basis. Typically, we have to think of reflux as two different types of reflux. There's what I call the standard esophageal reflux where people actually feel burning or chest discomfort or have difficulty swallowing. This can often be accompanied by bloating, feelings of fullness after meals typically because the stomach and the esophagus are connected together by the sphincter, which is malfunctioning. The other type of reflux is sometimes is referred to as silent reflux or LPR for laryngo-pharyngeal reflux and is primarily what we would call regurgitative, which is to say the stomach contents come up the esophagus into the area of the throat without sensation of pain in the chest or difficulty swallowing and no burning. Those patients present differently, and may instead have a chronic cough, chronic sinus problems, or voice alterations where you could lose your voice entirely and have hoarseness. There can be damage to the vocal cords and some people have late onset of asthma or bronchitis. We're finding more and more, many of our sleep apnea patients actually are refluxing silently as a cause for their sleep apnea.
That's what Bob had. He's the type that really didn't have any symptoms except for sleep apnea.
Dr. Noar: Bob was remarkable because he presented without symptoms of reflux, without the typical difficulty swallowing or heartburn, but was seen because he was having difficulty sleeping at night. When we took his history it became apparent to me that he was being awakened suddenly with no explanation, but with associated changes in his heart rate. As a result, we did a study and it demonstrated clearly that he was consistently refluxing up into his throat and likely aspirating at night. Our decision at that point was to offer him medication, which was not functional and did not work for him. We offered him the Stretta procedure and what's impressive about Bob's case is literally within six to seven months after having had the procedure, he's off of his medications and he's sleeping mostly through the night once again. He's doing much better off his CPAP and not really requiring any medication.
And his case is rare? The majority of GERD patients do experience symptoms?
Dr. Noar: I would say 50 percent do have typical symptoms of heartburn. The silent refluxers or the regurgitative types who have laryngeal symptoms probably represent the other 50 percent that are not always being recognized as having GERD. In the past, we would say the majority of patients had classic heartburn symptoms, but now are recognizing that it's much larger than that. There's this other 50 percent of that population, probably another 20-30 million people who have more of the laryngeal type symptoms of reflux only.
Kathy was telling me that part of the reason she chose to do the Stretta procedures was because she was concerned about the medication and the side effects it could cause like osteoporosis.
Dr. Noar: There's been a lot of recent press about the chronic use of proton pump inhibitors and while a lot of the evidence is soft, I think there's a fair amount that's actually quite important such as problems with low magnesium levels as well as issues with osteoporosis. I think that there's also some newer evidence that's fairly alarming because there is an associated increase in risk of heart attack in many patients. We have many patients who come and have an issue with taking medication long-term. The Stretta procedure can significantly help them. We've been studying this since the year 2000 and I was the first clinical adopter of the technology once the pivotal FDA trials were done. In 2000, we began a 10-year prospective intent-to-treat analysis trial in order to see how effective this would be long-term. We published the four year data during which time we found that 85 percent of the patients were asymptomatic and off of medication. But even at 10 years it seems to have an equally durable effect. We find 72 percent of patients no longer have reflux symptoms at all and over 40 percent are actually no longer taking any form of medication at all. Not even "as needed" medication. So we know it's a great procedure, it helps people get off medications, it's safe and at the same time it eliminates their symptoms.
And this is been around for how long?
Dr. Noar: It was approved by the FDA in the year 2000.
So the new study that was published in February, can you tell me the results from that?
Dr. Noar: Sure. The paper that was published in February was the result of this 10-year trial. There were some very expected results and then some very unexpected results that are interesting. Our primary endpoint was to expect a large number of patients would become asymptomatic after 10 years, and we found that 72 percent of patients were no longer having any reflux symptoms 10 years later which is substantial. The other endpoints were to see increased satisfaction in these patients and to see a significant number of patients no longer requiring any medication. That number ended up being 41 percent. So 41 percent of the patients were no longer taking any form of medication, not even an antacid from time to time. If we were to compare that to the only other technique that has published any long-term data, which is a surgical procedure called the Nissen fundoplication; the best results found regarding the surgical procedure would be 38 percent of patients no longer taking medication. However, that data was cut off at approximately seven and a half years in the analysis. At 10 years, we really have quite the advantage with 41 percent off medication and 72 percent of these patients entirely asymptomatic. Now the one other point that I think is important in this study came when we were looking at the patients who had Barrett's esophagus, which is considered to be a premalignant condition, which is the result of reflux. You have to have a lot of reflux to have Barrett's esophagus. We found that 85 percent of the patients who had classic Barrett's esophagus at year 10, had spontaneous disappearance of their Barrett's tissue. There was spontaneous regression of the tissue so that they no longer had Barrett's esophagus. Their symptoms got better, their reflux was improved, they were using less or no medication and this premalignant condition actually disappeared in 85 percent of the patients who had it. Also importantly, the Barrett's tissue never got any worse. Also very interestingly, if we look at the expected percentage of chronic refluxing patients who would be expected to develop cancer within a period of time, that number is approximately 1.83 percent. Among this population we would have expected to see at least a couple of them come down with esophageal cancer. In fact, not a single patient who was in the 10-year trial developed esophageal cancer following the Stretta procedure. By protecting against the reflux, the Stretta procedure may even convey protection against esophageal cancer.
Bob had Barrett's correct?
Dr. Noar: Bob has Barrett's yes, and Kathleen also has Barrett's esophagus.
Are there any side effects from the Stretta procedure?
Dr. Noar: Clearly there are no long-term side effects from the procedure. There has never been a problem with difficulty swallowing, and patients return to normal activity and diet the day after the procedure. Additionally, if you have Barrett's esophagus and significant chronic reflux, the data suggests that there is an 85 percent rate of spontaneous regression which is really important in terms of not only limiting exposure to reflux but also limiting the potential to develop cancer. It would also end up saving money for the health care system because it would reduce the need to be screened as often. There would be no reason for periodic screening for your Barrett's tissue once the reflux-caused Barrett's tissue disappeared.
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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