LOS ANGELES, CA (Ivanhoe Newswire) - From babies to grown-ups, it's a digestive problem that can hit anyone. For 25 million Americans GERD is a painful issue they deal with every day. Now doctors are offering patients relief with a medical sewing machine of sorts.
Alexa Hollander has a sweet gig working at her favorite yogurt shop.
"I love yogurt," Alexa Hollander told Ivanhoe.
What she didn't love was the sudden pain she started feeling two years ago every time she ate.
"I'd take one bite and instantly get this really bad taste in my mouth," Alexa said.
Alexa was diagnosed with GERD, a chronic digestive disease that happens when stomach acid flows back into the food pipe causing inflammation.
"Even if I didn't eat it happened. I'd wake up, it happens. I'm taking a shower, it happens - running, walking, walking to school, anything, no matter what," Alexa said.
For two years she tried different types of medication but nothing worked.
"That's when I realized we have a serious issue here," Deborah Hollander, Alexa's mom, said.
"As the esophagus gets more and more injured from the acid, the cells in the esophagus can start to change, to a specific kind of change in the cells in the esophagus that can predispose you to cancer down the road," Miguel Burch, M.D., an associate director of general and minimally invasive surgery at Cedars Sinai Medical Center, said.
Before that could happen, Doctor Miguel Burch performed a new surgery to help Alexa keep her food down. Without incisions, Doctor Burch gathered part of Alexa's upper stomach, pinched it and sewed it around the lower end of the esophagus, creating a one way valve that allows food to pass through the esophagus and into the stomach , but it doesn't allow the acids to come back up.
"It's a very innovative way to sew, by doing that and reshaping her valve, she was able to within 2 hours to have her disease under control again," Dr. Burch said.
In a three year clinical trial, 80 percent of patients were off their daily anti-acid medication after the procedure and were able to eat more types of food.
"They gave me apple juice and I hadn't had apple juice in two years," Alexa said.
Alexa is back to being a normal teenager and ready to tackle her most important job, serving and eating her favorite foods.
Because there are no incisions in this procedure, there's minimal scarring and patients should be able to return to normal activities within days.
Doctor Burch said patients might experience a sore throat after the surgery but it should go away in just a few days.
BACKGROUND: GERD stands for Gastroesophageal reflux disease. When you swallow, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again. However, if this valve relaxes abnormally or weakens, GERD can occur, causing frequent heartburn and disrupting your daily life. Over time, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems. When signs and symptoms occur at least twice each week or interfere with your daily life, doctors call it GERD. Conditions that can increase your risk of GERD include obesity, hiatal hernia, pregnancy, smoking, dry mouth, asthma, diabetes, delayed stomach emptying, connective tissue disorders, such as scleroderma and Zollinger-Ellison syndrome. (www.mayoclinic.com)
SYMPTOMS: GERD signs and symptoms include: a burning sensation in your chest (heartburn), sometimes spreading to the throat, along with a sour taste in your mouth; chest pain; difficulty swallowing (dysphagia); dry cough; hoarseness or sore throat; regurgitation of food or sour liquid (acid reflux); or sensation of a lump in the throat. Seek immediate medical attention if you experience chest pain, especially when accompanied by other signs and symptoms, such as shortness of breath or jaw or arm pain. These may be signs and symptoms of a heart attack. Make an appointment with your doctor if you experience severe or frequent GERD symptoms. If you take over-the-counter medications for heartburn more than twice per week, see your doctor. (www.mayoclinic.com)
TRANSORAL INCISION-LESS ANTI-REFLUX SURGERY: The procedure, using the EsophyX device, is closely based on the well-established principles of conventional anti-reflux surgery and delivers similar results. The main differences between TIF and conventional surgery are:
Incisionless Approach: Conventional antireflux surgery involves accessing the anatomy via 3 to 5 abdominal incisions. TIF does not require any incisions and is performed through the patient's mouth.
No Dissection: Laparoscopic surgery requires the surgeon to dissect, or cut around, relative anatomy which can increase the risk of complications and adhesions as well as recovery time.
Hiatal Hernia Repair: The TIF procedure is best suited for patients with hiatal hernia less than 2 cm.
Strong Safety Profile: To date, over 10,245 procedures have been performed with fewer adverse events and complications than conventional anti-reflux surgery
Due to the unique approach of the procedure, patients typically experience less discomfort, faster recovery and fewer adverse effects. Results to date are comparable to those of conventional anti-reflux surgery. (http://www.gerdhelp.com)
Dr. Miguel Burch, Associate Dr. General Surgery and Minimally Invasive Surgery, Cedars Sinai, discusses a new surgical technique to reapir GERD without incisions.
We are here to talk about acid reflux and GERD, is it the same thing?
Dr. Burch: People talk about GERD as a really big statement, I've got GERD. GERD, or gastroesophageal reflux disease is really a complex set of symptoms that all reflect a non-working lower esophageal sphincter of the esophagus. As you know, obesity is a bit of an epidemic in this country and so we're seeing a lot of people with obesity develop GERD. That has a lot to do with the pressure of the abdomen and so just having the weight distributed in the abdomen and the belly will push on the stomach and push acid back up the esophagus.
It's not just something that's uncomfortable but it can be really dangerous too?
Dr. Burch: GERD which presents as either regurgitation or heartburn predisposes the esophagus to acid and injury from that acid. As the esophagus gets more and more injured from the acid, the cells in the esophagus can start to change, they can undergo what is know as metaplasia and it can predispose you to cancer down the road. So yes, I think GERD in and of itself it's not dangerous, it's the acid damage to the esophagus that's really the dangerous part.
When you met Alexia what was she like?
Dr. Burch: Alexia is a vibrant sixteen-year-old, now seventeen-year -old . When I first met Alexia she was not exercising, her grades were dropping in school, she wasn't able to sleep - she was sleeping sitting in a chair every night. She had very bad heartburn, really it limited her quality of life which is tough for a seventeen-year-old girl.
We generally see it in older people and we think that's life but with a teenager and it affecting her like this.
Dr. Burch: I think the interesting part is , because GERD is a progressive disease, we forget what it's like to feel good, you forget what it's like to go out to a restaurant and just order a hamburger. As you turn older and older and GERD progresses little by little it sort of insidiously changes your lifestyle. If you look back and say, gosh ten years ago I could eat hamburgers and I could go to bed late and I could eat spaghetti or have red wine, etc. everything was fine. When you're sixteen years old those changes seem to happen over night. So for Alexia, I think the changes really did affect her more than they would somebody older because she would look around and see all the other sixteen- and seventeen-year-olds do what they do and she was unable to do any of that stuff.
Is the first line of defense medication?
Dr. Burch: The first line of defense is lifestyle change, lifestyle modification. So things that really cause reflux, like coffee, chocolate, alcohol, tobacco, avoiding all those things. And then you sort of work up from there, like you should for everything. So lifestyle changes first and then things like propping the head of the bed up at night if you have reflux at night. Eventually medication is where you start and you start with the lowest strength and work your way up to the highest strength.
But all of that didn't stop that for Alexia?
Dr. Burch: No. The problem with medication is that what medication is great at is stopping your stomach from producing acid. That is not controlling the primary problem for most people. For most people the primary problem is the fact that the valve at the end of the esophagus doesn't work well. So having acid in your stomach is part of normal health and if that valve [at the end of the esophagus] doesn't work and you're having acid splash on the esophagus that's the cause of the pain. What we do when we give people acid blockers is we stop the acid production. So you're still having fluids and all the stomach contents splash on the esophagus it just doesn't hurt anymore. And that's the big difference for Alexia - even though she had little acid, she still had regurgitation. So she works in a yogurt shop and every time she would bend over to get yogurt she would have her last meal in her mouth. Which is very difficult for anybody to tolerate. So the thing about medications is they don't really address the primary problem. For most of us, me included, anti-reflux medication is just part of life a couple of days a week and if that's all it is it's not a big deal to take it. But if it affects your daily living so much you have to take it every day ,then it really changes things.
But you were able to solve Alexia's problem in basically a couple of hours.
Dr. Burch: Yes, Alexia came and so we evaluated her and made sure she was an appropriate candidate for intervention and then we presented to her and her parents all the spectrum of options. One of which was the new endoscopic procedure for taking care of reflux. Taking care of the primary problem of reflux. So in a couple of hours, exactly, through an incisionless operation through an endoscope we were able to change the anatomy of her lower esophageal sphincter and cure her of her disease.
Can you tell us how that works exactly?
Dr. Burch: What we do is we go down the esophagus with an endoscope and a sewing machine. The endoscope allows access to the part of the esophagus and the stomach that are weak from the GERD, from the reflux disease. With that sewing machine what we do is we actually create a nipple valve so that it's a one-way valve that allows food to pass through the esophagus and into the stomach but doesn't allow the acids to reflux back up on the esophagus. And this sewing machine uses the standard thread that we use in the operating room. It's just a very innovative way to sew. By doing that and reshaping the valve she was able within two hours to have her disease under control again.
She said it was amazing, she was offered apple juice and she was afraid to take a sip.
Dr. Burch: I think Alexia was really unique in the sense that seeing somebody who was sixteen years old sort of get their life back to what a normal sixteen year old is supposed to be doing was touching to see.
How would you have treated that before, would it be open surgery?
Dr. Bruch: Well you know surgery is in evolution, it always will be. Ten to fifteen years ago we would have made an incision that's about a foot long in the upper abdomen to do it. Eight years ago we would do it laparoscopically through six small incisions in the abdominal wall. In the last two years I've been doing the endoscopic incisionless fundaplication – no incision on the skin, a much faster recovery because of less swelling in the area in general. So really it's changed a lot. And I think the side affect profile for the endoscopic fundoplication is much better than it is for other operations that we can offer.
Can you tell us that again?
So because when you do an open operation or even a laparoscopic operation to some degree, there's more swelling in the area because you've got to move more organs around to get to the organ of interest. Versus endoscopically the first thing we see is the area that we need to work on. So there's no moving any organs around to get to that area. That alone decreases the amount of swelling you can get in the organ. So post-operatively, or after the procedure, people's biggest complaint just happens to be having difficulty swallowing or having a lot of bloating because of the swelling. After endoscopic fundoplication that really is a very small problem. Usually it gets better in a few days and after that people go on with their life, back the way they had been before the procedure or better than before the procedure.
Dr. Bruch: Everything has got its risks, the risks for the endoscopic procedure are actually less than they are for laparoscopic or open procedures because again the organ of interest is immediately available and it's fairly easy to take care of right there.
Is there anyone you wouldn't do it on?
Dr. Bruch: I wouldn't do it on anybody who has a BMI over thirty or is morbidly obese because we know that the factors that are causing the reflux in them (pressure from the weight of the abdomen) are not quite controllable by fundoplication. You'd have to do some lifestyle modification first, get some weight off.
People with really large hiatal hernias, which is when the stomach slips up into the chest through a defect in the diaphragm, those patients aren't really candidates for the surgery. It's doable and we've done them before but I think the outcomes are much better doing a formal repair.
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