Health Chats
GERD/Heartburn: Advances in the Treatment of Severe GERD
Wednesday Apr 07, 2010, 05:00PM - 06:00PM (EST)
Chief of Bariatric Surgery Service
Beth Israel Medical Center
Surgery, New York, NY
GastroEsophageal Reflux Disease (GERD), also referred to as heartburn, is reflux and regurgitation of the contents of the stomach into the esophagus that is frequent and severe enough to impact daily life and may even damage the esophagus. Normally, after swallowing, a valve between the esophagus and stomach opens to allow food to pass into the stomach, then closes to prevent reflux of the food back into the esophagus. In GERD, this valve is weakened or absent, causing the acidic digestive juices from the stomach to flow back (or reflux) into the esophagus. <br><br> The esophagus is not designed to handle the acidic environment of the stomach. This reflux is not only painful and uncomfortable, but can burn the esophagus, cause chronic inflammation, and can lead to major damage and cancer of the esophagus. GERD is one of the most common diseases, with over 60 million Americans experiencing symptoms at least once a month. For many lifestyle modifications can significantly decrease the occurrence and severity of GERD and are usually the appropriate first step in the treatment process. <br><br> Drug therapies such as proton pump inhibitors (PPI) and H2 (H2RA) blockers reduce ‘typical' GERD symptoms caused by acid exposure, but they are not effective in treating non-acidic or alkaline reflux and ‘atypical symptoms' like asthma, or chronic cough. Even if drug therapy is effective, it may be needed for life, since symptoms and disease return as soon as medication is stopped. Surgery is sometimes indicated for patients with severe GERD who have failed less invasive treatments. Laparoscopic repair has been shown to be effective in 75-90% of patients in alleviating heartburn and 50-75% in alleviating cough, asthma, and laryngitis. Unfortunately, even laparoscopic surgical repair can be invasive and typically has a high incidence of side effects like gas bloat and difficulty swallowing. For this reason, less than 1% of GERD patients currently choose invasive surgical therapy to treat their condition. <br><br> Transoral Incision Free Fundoplication (TIF) is the third wave in the evolution of surgical procedures for the treatment of GERD and builds upon the principles of proven open and laparoscopic procedures used to effectively treat the disease. The key differences are that EsophyX TIF is performed through the mouth, does not require any incisions, and does not dissect any part of the natural internal anatomy. Benefits include reduced recovery time and discomfort and most patients are able to return to work and normal activities within a couple of days after the procedure. <br><br>
I have been told that I have to have a surgical procedure where they unhook my esophagus and wrap it around my stomach and reattach it to tighten it so no more reflux will come upl  I have reflux so bad that I have to use straight liquid lidocaine for the pain.  Is this surgery done down the throat, what are the dangers, and is this new surgery?  I am very afraid as it sounds radical.
This will be the last question for the chat.
Dr. Elliot Goodman:
The procedure you describe does not unhook the esophagus, but it does wrap the stomach around the esophagus to reconstruct the faulty valve, to cure the reflux.
Dr. Elliot Goodman:
Traditionally this is done through one large, or several small abdominal incisions.
Dr. Elliot Goodman:
It can be done through the throat, using a new technique called Esophyx.  Esophyx is less invasive, has a shorter recovery period and a lower risk of side-effects than traditional anti-reflux surgery.
Thank you Dr. Elliot Goodman and all MedHelp members for joining us here today!
Dr. Goodman, please let us know how patients can get in touch with you in the future!
Dr. Elliot Goodman:
Thank you so much - I really enjoyed this session!  Patients in the US can call me at:  212-844-8838.  Patients in the UK can call toll-free 0800 0988 435