If You Suffer From Reflux

If you suffer from reflux, despite taking medications, there is good news in the news!  Procedures for reflux have become refined over the years, and there is now reason to believe that a simple procedure can rid you of reflux disease.

Now, most of you are familiar with the symptoms of reflux, mainly the heartburn that you feel after a meal or drink.  In simple cases an over the counter antacid will immediately improve your symptoms.  But, as reflux gets worse, there are other signs and symptoms that you may not realize is reflux disease.  For instance, having food or fluid come up when you lean over to pick something up or when you lie down to rest.  Many people have throat and sinus symptoms such as hoarseness, sore throat, what feels like a lump or pressure in the throat and persistent mucus and sinus drainage.  A persistent cough or clearing of the throat may be reflux, and it’s estimated that up to 80% of adults with asthma have reflux induced asthma.

If antacids are not treating the problem adequately, or if your symptoms recur day after day, people look for stronger medicine.  The next line of treatment is what is called an H2 antagonist – like ranitidine, which is now an over the counter medicine.  This medicine reduces the acid production by about 60%.  The most powerful medications we have are called proton pump inhibitors.  You’ve seen TV ads about taking these pills.  They reduce acid production in the stomach by about 90%!  Very strong medicine indeed!

So if you have reduced the acid in the stomach so much, why do people still have symptoms?  Well, the first reason is that these medicines are designed to treat esophagitis, an irritation or erosion of the lining of the esophagus.  Normally, a valve between the esophagus and the stomach keeps acid and enzymes of digestion out.  Overeating, and foods that slow the stomach emptying can cause a full stomach to spill contents through the valve and injure the lining of the esophagus.  By reducing the acid content you allow these injuries to heal, because most of the time the esophagus is fairly well protected from the acid and enzymes in the stomach.  Typically 90% of cases are healed within 6 to 8 weeks.

So again, why do you still have to take medications?  Well, sometimes the valve deteriorates, allowing acid and enzymes to splash into the esophagus all the time.

diagram1 In that case, even reducing acid by 90% still causes symptoms.  The fluid still has digestive enzymes, which injure the end of the esophagus, but can also move all the way up the esophagus to injure the throat, sinuses, and even the lung passageways.  Medicines can treat the acid, but they can’t fix a broken valve!  Up till now, surgery to repair the valve would be the next step.

So, in the past, surgery would use some of the stomach to recreate the valve, but over time we realized that patients were having good control of their reflux, but a lot of side effects to the surgery.  Bloating, gassiness, having difficulty swallowing….it’s like they traded one problem for another.  So the traditional surgery, called a “NIssen Fundoplication”, works well, but is reserved for only the worst cases of reflux.  This leaves a lot of patients with reflux symptoms despite being on the maximum medical treatment available.  What do they do?

Well, that’s the good news.  Since 2007, a new technique to recreate the natural valve has been gaining popularity in the United States.  It’s called “Transoral Incisionless Fundoplication” or TIF for short.  Like the Nissen, TIF controls reflux very well.  On average, 80% of patients control their symptoms without the use of daily medications.  Meaning they take no medication, but eat and drink like they did before they had reflux.  Also, in over 30 published studies, the incidence of the Nissen-type side effects has been practically zero!  Some patients even reduce the bloating and gassiness they had before surgery!

diagram2How does it work?  Well, a device is placed through the mouth and into the stomach.  It grabs the junction of the esophagus and stomach and folds the stomach back into place.  Then it places sutures to hold it in place until it heals.  When it heals, it becomes a permanent change.

How good does it work?  Recently, a head to head trial of medicine vs surgery showed that medicine controlled heartburn symptoms only 13% of the time, while TIF controlled heartburn 90% of the time.  Regurgitation was controlled by medicines 50% of the time, and TIF controlled regurgitation 97% of the time.  Atypical symptoms were eliminated 84 to 100% of the time with TIF.  Importantly, 100% of patients were daily acid medication before this study.  After TIF, only 8% were still on daily medication.  An amazing difference if you are tired of taking medications.diagram3

Finally, there is one more thing to consider.  Medicines are generally safe, but they have their own list of side effects.  We know that acid suppression in the stomach decreases the ability to absorb many important nutrients, especially iron, magnesium and calcium.  Calcium deficiency from chronic medicine use has been shown to increase fractures in women. Also, the acid helps defend against many bacteria, so the incidence of pneumonias and colon infection and diarrhea is higher with acid suppression.  There are studies that indicate that acid medications increase the rate of heart attacks in susceptible patients, and interfere with the absorption of certain other medications that patients may be on.

So if you are tired of reflux symptoms, or have symptoms of reflux and didn’t know it, get evaluated by an expert in TIF.  If you have been on medications for years, and are tired of taking them, now is a good time to look at this important new advance in reflux therapy.