By James C. Rosser, Jr., MD, FACS Advanced Laparoscopic Surgeons Florida Hospital Medical Group
What if your heartburn was so bad, you needed surgery to cure it? That’s a reality for thousands of Americans who receive some form of surgery to relieve their heartburn problems and reduce their risk for esophageal cancer. Learn more about Linx, a new surgical implant that can help relieve the pain for good.
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus, the tube that goes from the mouth to the stomach.
Because your stomach contains acid, this reflux can irritate and damage your esophagus, causing heartburn and potentially leading to cancer. Sometimes this reflux causes obvious symptoms, while it can often be "silent."
The most common treatments for GERD involve medication and lifestyle changes. Taking acid blockers (like a PPI or H2 blocker) or antacid medications help to reduce the esophagus-damaging acid in the region. Doctors also recommend avoiding alcohol and the corrosive C’s: caffeine, chocolate, citrus and canned foods. This often works; however, approximately 10 to 40% of patients with GERD fail to respond to medical treatments and need something more permanent, including one of many surgical treatments.
Some of the available surgical techniques include:
- Nissen Fundoplication: This has been associated with an 85-90% improvement rate in patients. In this procedure, the surgeon would wrap a portion of stomach wall around the base of the esophagus. This can be done laparoscopically, leaving only 3-4 small scars on the abdomen.
- Gastric Bypass: These surgeries, particularly the Roux-en-Y procedure, which have been designed for weight loss in the morbidly obese, show promise for GERD.
- Endoscopic Devices: These devices include the EndoCinch, the EsophyX, or the Stretta. They are placed on the inside of the esophagus with an endoscope to bolster the sphincter. These devices boast as high as a 70% success rate.
- Surgically Implanted Rings: By placing a ring prosthesis around the junction between the esophagus and the stomach, the reflux of acid from the stomach has less chance of reaching the esophagus and causing damage. One prosthesis, the Angelchik, was widely used; however, it fell into disfavor because it had a high complication rate. However, a newer ring design, the Linx Reflux Management System, may solve the problems people had with the Angelchik.
How does the Linx Device work?
The Link Reflux Management System is one of several new developments in surgical GERD treatments. The device itself is a string of magnetized titanium beads that is placed around the esophagus-stomach junction (also known as the lower esophageal sphincter), like a bracelet. The magnets would be strong enough to keep the end of the esophagus closed, and keep stomach acid in the stomach; however, the magnets would allow for the lower esophagus to expand, so food would be able to pass through. So far, over 600 of these devices have been implanted around the world with outstanding results. While more research needs to be done in order to make this a regular surgical treatment for GERD, Linx has received much praise in the media.
When Should I Consider Surgery for My GERD?
If your primary care doctor has diagnosed you with GERD, you should try lifestyle modifications and medications first. They are cheaper and effective for most people. However, you may want to consider alternatives if the medications fail, if you need a very high amount of medication, or if your doctor finds evidence of severe esophageal irritation. Those who have developed upper respiratory symptoms because of GERD (hoarseness, wheezing, nocturnal asthma, cough or dental erosion) may also want to consider surgical interventions.
Talk with your doctor to discuss the pros and cons of surgery and to initiate pre-surgical tests on your esophagus.