Acid reflux, heartburn and indigestion are all forms of gastroesophageal reflux disease or GERD. This common problem afflicts over 20 million people in the United States on a daily basis. As a surgeon who treats patients with some of the most severe symptoms of GERD, I was recently struck by the fact that very little has changed in the treatment of the debilitating problem over the last several decades.
Medications have always been the primary treatment for patients with GERD. TUMS, Rolaids, alka seltzer are easy over the counter remedies that could provide instant but only short-term relief. More potent medications called H2 receptor antagonists (commonly known as Zantac, Pepcid AC) brought about longer lasting relief. These medications were great but many patients experienced a relapse of symptoms.
The newest medications for GERD are called proton pump inhibitors or PPIs (commonly know as Prilosec, Nexium, Aciphex, Protonix and Prevacid) are over 20 years old. If you seen an ad for one of these medications, they were touted as a 24 hr cure for GERD. But as many patients have come to experience, they don’t control all of the symptoms, with as few as 50% of patients getting complete 24-hour relief from symptoms.
Most patients with GERD are not even aware that surgery is an effective option for treating GERD. The 1% of GERD patients who have undergone antireflux surgery say they are tremendously grateful that their GERD symptoms controlled without having to take another pill. But, the most common procedure, Nissen fundoplication, which controls acid reflux equally if not better then twice a day Prilosec, can have side effects patients must tolerate in exchange for no symptoms of GERD.
For most patients with GERD, surgery may seem overly drastic unless you have severe symptoms. And, for many others, symptoms are not completely controlled with pills or you may have to restrict your diet considerably in addition to taking the pills to lessen the symptoms. Others will sleep sitting up right in the chair or won’t sleep at all because they are constantly having reflux.
There has been no new or revolutionary therapy for GERD in over 25 years when PPI’s were introduced. This all changed in March 2012 when a new device call the LINX was approved after 4 years of evaluation and testing by the FDA.
This device is a series of magnets in the form of ring and implanted around the bottom of the esophagus by a short, 40 minute laparoscopic procedure.
The ring of magnets is designed to stay closed and prevent the reflux valve from opening thereby preventing acid from the stomach move up into the esophagus. The magnets will open up the ring when people are eating to let food in much like a person’s native reflux valve. The LINX will also open to let people belch and if necessary, vomit, which is one of the side effects of the Nissen fundoplication people tolerate.
Of all the GERD treatments I have seen, I am truly excited about the LINX and hope to have it available at Swedish in the coming months. It is a simple procedure that controls GERD in over 90% of patients and allows over 80% of patients to stop their GERD medicine and enjoy a regular diet.