Updates on LINX - GERD reflux management system

Updates on LINX - GERD reflux management system

By Brian E. Louie, MD
Director of Thoracic Research and Education

Since my initial LINX blog post 20 months ago, we have been engaged in a dialogue with patients from around the world who suffer from gastroesophageal reflux disease or GERD.  Despite my initial trepidation to “blogging”, this has been a rewarding experience to hear about patient’s problems, their concerns about the current treatments (PPI’s and Nissen fundoplication) and simply interacting with them.  I thank the patients who have taken time to share their thoughts on the blog.


When our social media manager asked me to provide an update on LINX, I realized that I have been simply responding to patient’s questions and I haven’t posted any of my thoughts or updates on what is happening with the LINX device.
There are some exciting developments for patients who are interesting in having a LINX implanted.

Use of MRI and LINX
  • Torax, the company who designed and manufactures the LINX device, has received FDA support for the use of MRI with the LINX device.  This conditional approval allows for patients to undergo and MRI that is 0.7 Tesla or less.   I am trying to clarify with our radiologists what a 0.7 Tesla MRI will cover.
Medicare coverage
  • For medicare patients, LINX now has a dedicated procedure code that allows for payment to cover the cost of the hospital portion of implanting the LINX device.  The surgeon’s fee is a separate code and fee and is usually covered.
Insurance update
  • For patients with non-medicare insurance, the battle continues.  But, the data from around the country shows that more patients are successful in getting approval for LINX than previously with upwards of 50% being approved.  It is still taking up to 120 days for approval but with more data accruing each month I think insurers are beginning to pay attention.
Since the insurance battle has been about lack of data supporting the LINX compared to Nissen, we (Drs. Farivar, Aye and Vallieres) have just completed a study comparing the two devices.  As I write this, I am on my way to the Society for Thoracic Surgeons annual meeting to present our findings, which will hopefully be published in the Annals of Thoracic Surgery later this year.
This study shows that LINX and Nissen are the same in terms of treating the patient’s symptoms of GERD, improving the patient’s quality of life and normalizing the level of reflux in the esophagus without the need for PPIs.   However, LINX is a shorter operation, has less complications and results in a more physiologic sphincter since patients are able to belch and have less bloating or gas the Nissen patients.
This promises to be an exciting year for patients with reflux.  The addition of LINX to the treatment options for GERD allows us to individualize the treatment.  For patients with large hiatal hernia, Barrett’s esophagus and severe reflux, a Nissen fundoplication performed in an experienced center is still a better option.  But, for patients with a small hiatal hernia who are dependent on PPIs but whose reflux is not well controlled, a LINX device is a great option.
Thank you to all the patients who have read and interacted in this blog.  I look forward to reading your posts in the coming year.
Brian E. Louie, MD
KS, at this point in your recovery, it is difficult to say what will happen. I've seen it go both ways meaning patients improved and had no symptoms and othera continued to have problems

I would encourage you to work through this with your surgeon. It's likely if you have ongoing symptoms they will want to re study you to determine what's going on
5/18/2015 7:39:39 AM
I had the LINX 10 weeks ago. At first I experienced full resolution of symptoms, then food got stuck badly and reflux returned for 5 days, then resolved completely. At 6 weeks food got stuck again and reflux returned for 4 weeks now. Do you think there is any chance at this point that I might return to the "perfect resolution" I experienced or can we at 10 weeks post op expect it to stay this way.

Thanks a lot.
5/14/2015 4:03:28 PM
Kelly Fromm
H Dr Louie,

I have been dealing with GERD for 15+ years, and have been following the typical increase of my PPI meds year after year. I have now been on 60Mg of Dexilant twice a day for the past 5 years and would like a better solution. I have met with a surgeon locally here in Spokane WA, and am considered a good candidate for Nissan, but am more interested in the benefits that LPR would provide me. I would like to understand what I need to do to be evaluated as a candidate for this surgery at Swedish. How do I become one of your patients?

Kelly Fromm
5/7/2015 5:00:29 PM
Brian E. Louie, MD
Pat, I'm sorry to hear that you haven't had a perfect outcome. LINX is effective at both acid and bile, but it doesn't work in everyone and its not clear just who it doesn't work well in. We know that 85% of LINX patients are off medications. That tells you that some patients still need some medical treatment. The challenge you face is that there is no medicine for bile reflux.

If your LINX is above your diaphragm then it likely has migrated. Your best bet to control your symptoms may be to have the LINX removed and converted to a fundoplication to control the symptoms you have. What did your LINX surgeon tell you?
3/17/2015 9:36:30 AM
Linx was implanted in May 2012. I continue to have bile reflux. How is it possible? I thought it would hold back both acid and bile. Hida scan negative. Endoscopy negative. Barium showed Linx tenting or riding above the diaphragm. Is this normal. Should I have Linx removed. Yes, we've discussed with surgeons. I am very thin and eat healthy with no offending foods, nothing 2hours before bed and bed still raised. Suggestions please.
3/9/2015 7:46:27 PM
Brian E. Louie, MD
Giani, it sounds like you are on your way toward a LINX. There are still many factors that need to be assessed before I would implant a LINX in you. The size of the hernia, the degree of reflux that reaches the top of your esophagus and status of the native LES sphincter are all key factors in determining whether a LINX will control all of your reflux.

In certain cases, a fundoplication will be a better choice to control all of your symptoms. I hope that your tests all look good so that you can receive a LINX.
3/9/2015 10:48:09 AM
Brian E. Louie, MD

I'm glad that you feel better with the changes you have made. I"m not sure what you want my opinion on. With what you describe, it sounds like you had appropriate treatment with a fundoplication. We have not offered patients with lung related complications a LINX device because its so important to control the reflux in your situation.

At this point, I would suggest you talk with your physician about re-evaluating you with a pH probe, EGD and manometry to see what is going on. It is certainly possible to revise your fundoplication if its not controlling your reflux and protecting your lungs. We have just completed a study showing that revision of the fundoplication results in very similar results to the first time a patient underwent fundoplicaiton.
3/9/2015 10:47:21 AM
Brian E. Louie, MD
Darla, the CRE outbreak has been in the media a lot lately. This particular resistant bacteria has been tracked to a specific endoscope used only for ERCPs. Patients undergoing GERD evaluation are not exposed to these particular scopes and should not be at risk.
3/9/2015 10:45:35 AM
M Shaalan,MD
I had Fundoplication in 2/2009 for GERD,LPR,Barrett`s,Hiatal hernea and ILD in both lungs. Now I have pulmonary fibrosis with recurrence of All the above symptoms. On nexium (40mg BID X 9 months),I had pneumonia + severe alleric Rhinitis and recurrence of Reflux.
I stopped Nexium (gradualy) and REGULARLY USE gaviscon advance suspension /ANISEED .I got my BMI down to 23,rased my bed and Never eat 3 hours before lying down (on left side).All this for 8 weeks . I feel better & no reflux,and have an appointment to see my MD.
Your openion will be deeply appreciated.
3/5/2015 5:20:56 PM
How is Swedish handling the risk of CRE with the use of endoscopes during procedures?
3/4/2015 5:40:51 PM
3/2/2015 10:05:21 PM
Brian E. Louie, MD
Jeff, I would encourage you to be patient. Unfortunately, the insurance approval takes time but can drag out for a year in some cases. The approval rate in Washington has gotten much better and turn around times shorter but it can be a long wait.

We have had patients who are just too symptomatic to wait and have undergone Nissen and they are more than pleased with the results and haven't looked back. So I always counsel patients that Nissen remains a good option when you have an experienced surgeon.

Many centers like ours offer a self pay option. You might ask your surgeon if you can pay for the device and procedure yourself.
2/6/2015 11:49:47 AM
Jeff Howard
I have been a GERD patient for the past 1 1/2 years. I can tell you that my regurgitation of acid and food is crippling me beyond belief. After every meal, I usually wait an hour, regurgitate large amounts for an hour, then wait for a few hours to be able to eat again.

My surgeon in Nevada is attempting to get me the LINX procedure, but my insurance company is dragging their feet as expected. We are at the first round of appeals and expect to go through another.

Is there anywhere that will accept patients for the LINX without insurance? In your opinion, is it worth it to wait or will this just cause more damage to my esophagus? I don't want to alter my anatomy like the Nissen does, though I know it is a quick fix.
2/6/2015 12:13:00 AM
Abdul rehman
Dear Brian,

Recently, I underwent 24 hours ph impedance study and it showed that my transient les relaxation were 85 as compare to 73 normal. 45 of refluxes out of 83 came all the way up in my throat area. All these refluxes were non acid so my gastro doctor simply refused any surgery due to normal exposure of acid and ph.my les pressure is with in normal range. Endoscopy and bravo study normal with a very small hernia.My throat is constantly red and I do get symptoms with foaming in my mouth. My ENT confirmed the diagnosis of LPR. My question is if I undergo Linx, would it decrease the les relaxation of les because that is main cause of my throat symptoms.
2/1/2015 12:23:35 PM
Brian E. Louie, MD
Gail, the metals in the device are iron with a titanium coating. ‎ Most patients who have a reaction to cheap jewelry are fine with a LINX but you might see an allergist to find out what you are allergic to.
1/26/2015 11:29:30 AM
Gail Hutchison
Dear Dr. Louie, I am a long-term GERD sufferer and the Nexium is losing effectiveness. I am also approaching osteoporosis. Of the surgical solutions I have researched, I like the LINX best but am not sure about the metal used. I react with a contact dermatitis type of reaction when I wear cheap rings or earrings. (As do lots of people, I think) I'm not sure what element in the cheap jewelry is causing the reaction, so how could I be sure that I wouldn't have a negative reaction to the metal in the LINX device? Thanks for your help.
1/23/2015 5:00:20 AM
Brian E. Louie, MD

My response to your physician would be that there is grade 1 evidence (highest level of medical literature) that compares PPIs against surgery and shows that surgery is more effective in general and that patients taking PPIs need to take double the dose to come close to the same result as surgery. HOWEVER, those same studies do show that over 12-15 years, the Nissen does deteriorate in terms of reflux control, but PPIs also fail to control GERD over that same time frame.

When most patients do not have control of their symptoms with maximal medical treatment, surgery really is the only option. But, you need to find an experienced surgeon who does a lot of surgery since the results are dependent on volume.

Now, having said that everything I mentioned has to do with Nissen fundoplication. LINX has never been compared to PPI therapy. In a situation with Barrett's, severe reflux and LPR symptoms, a Nissen fundoplication would be a best bet to control reflux.
1/19/2015 12:26:21 PM
Thank you for so diligently answering questions on this thread. It is hard to find information on Linx.

I have Barrett's Esophagus (only a few cms around the sphincter), and rather severe reflux and LPR. I have been very interested in the Linx surgery, but my doctor does not recommend it. He is against any surgery for reflux, citing that symptoms reoccur so often in patients that he doesn't think it is worth the trouble.

Is this accurate, or should I seek a second opinion?

I am currently on 10mg of Rabeprazole (the most I can be legally prescribed in Japan) and a 3x dose of Mosapride, and it isn't helping.
1/15/2015 4:39:06 AM
Brian E. Louie, MD
If you are having recurrent symptoms of GERD and you have ILD, I suggest you see you surgeon for repeat testing to see if you are truly having reflux. You may need your fundoplication revised to address the problem. In your situation a LINX device is not advisable since you have had surgery already and to protect your lungs you need the best reflux control which is with a fundoplication.
1/12/2015 10:40:21 AM
M Shaalan,MD
I had Fundoplication in 2/2009 for GERD,LPR,Barrett`s,Hiatal hernea and ILD in both lungs. Now I have pulmonary fibrosis with recurrence of All the above symptoms. ANY ADVICE WILL BE APPRECIATED
12/31/2014 3:16:06 PM
Brian E. Louie, MD
Paul, congratulations on choosing the LINX device.

I'm surprised that these questions were not answered for you by your surgeon.

Yes, both bile and acid reflux are generally controlled.

After surgery, you'll have to learn how to belch with the device. Patients tell me that it can take some time to learn and others can do it without much thought. None of our patients experience reflux with the belch. No one is sure why but I suspect that the device opens just enough to vent air but keep the fluid in the stomach.
12/1/2014 10:05:12 AM

I have a question about LINX, for which I believe I'm scheduled for on Thursday. I have a combination of both bile and acid reflux, with a weak LES. I assume that the LINX is equally as effective at handling bile as well as acid?

I also belch quite a lot, and sometimes gets bloated. How does the LINX handle this with respect to allowing reflux through when belching, and increased intragastric pressure when bloating?

11/25/2014 8:21:55 AM
Brian E. Louie, MD
Katherine -

Thank you for your post. I would think that LINX is a possible option. You would need to undergo evaluation to determine if you are a candidate for surgery in general and then your surgeon can discuss which surgical option - LINX or fundoplication - would be best for your situation.

For patients from Alaska we usually collect up your records then have a conversation on the telephone to get an idea of what we think and then we would bring you to Seattle with a plan in place.

Let us know if we can help you out. Our clinic phone # is 206-215-6800.
10/6/2014 10:30:34 AM
Brian E. Louie, MD
Pat, I don't think we have an accurate number for that scenario.

We know that at most 1 % may be removed. After removal the decision that the patient and surgeon must make are to do nothing and use PPIs, create a Nissen or create a partial wrap such as a Toupet.

Each of these has been done but I don't have an exact number. That decision should be individualized to the patient and discussed with the surgeon
10/6/2014 10:15:19 AM
How many Linx have been removed and a Nissen done immediately during the same procedure.
9/30/2014 5:17:23 PM
My name is Katharine. I have spent the past 9 years battling GERD in Kenai, Alaska. The past 5 of those years I have had to learn to manage having severe laryngo spasms after coming down with whooping cough. I have had 4 endoscopy and many other tests, years of nexium and reglan therapy and as of now am considered a failed case and the only option I am given at this time by doctors is to have a fundoplication surgery or botox injections into my laryngo folds. My plan is to travel to Seattle if I decide to move forward with the surgery but if this may be another option for me please can you contact me.
Thank you kindly
9/30/2014 3:04:38 AM
Brian E. Louie, MD

I'm sorry that your experience with LINX has not been as satisfying as others have reported.

I have had a patient in my practice with a similar experience. Here, I don't use baclofen but prefer to use Levsin for the spasms. For my patient, we re evaluated the esophagus at 3 months after sugary with a pH probe and manometry to see if we could understand what was going on. He did have high pressures in his esophagus. We considered using different medications to relieve the spasms but it began to subside about month 4 and he declined more meds since he was getting better.

I think you should see your surgeon again. You may wish to ask the surgeon about reassessment. You could also ask about smooth muscle relaxing medications such as viagra, calcium channel blockers which have been used in spasms. Hopefully with some medication and time, things will settle down. If they don't, removal of the device is an option and in the studies 2-3% of the devices were removed for symptoms such as you are experiencing.
9/11/2014 2:32:21 PM
Cheryl Darby
I had the LINX procedure on May 20 after over 20 years of trying to manage reflux and small hiatal hernia with meds. About a month after surgery, I started having esophageal spasms -- very painful. My doctor prescribed baclofen and elavil. After a month, I was weaned off both meds. I still have spasms, but my doctor says I shoukd not need to take pain meds or baclofen. I also still have nausea and cannot vomit -- just saliva. I have bern told to be patient, that it might take 6-9 months before these spasms abate. This is debilitating, to say the least, and I'm wondering if there is anything I can do to improve my situation. I also have chronic sinusitus. I have greenish discharge but my ENT says my sinuses are clear.
9/9/2014 8:25:10 AM
Brian E. Louie, MD

Congratulations on being approved for LINX implantation.

It's natural to be afraid or concerned about any potential complications that arise from a surgical procedure regardless of how small or big the surgery may be. Most physicians quote the chances of a complication based on their own experience but also based on large studies completed around the world. The numbers are important but for the patient its effectively all or none event since in most cases you'll never be a recipient of a complication or you will get the complication.

Of the three potential issues you have listed, two of the three have some data to tell you about.

Erosion has been talked about a lot. Fortunately, as far as we know it has only occurred 4 times since the device was introduced. More than 2100 cases have now been completed so the likelihood of erosion is very small.

Pleural complications occur during Nissen fundoplication and repair of large hiatal hernias very routinely and rarely cause an significant problems. That being said, the likely chance of this occurring during a LINX procedure is unheard of because the surgeon shouldn't be anywhere near there.

Vagal nerve injury is more difficult to provide accurate information on. This is also very uncommon but even when it occurs it is not always clear what happened. Both vagal nerves can be seen and nothing done to them yet, the patient may have vagal nerve symptoms. At the same time, both vagal nerves can be injured and the patient may never even have a symptom. This should also be very uncommon after a LINX

I don't think I can allay your fears. The concerns you raise are important but fortunately are very, very uncommon after the LINX procedure.

Good luck in September.
9/2/2014 2:53:24 PM
Dr. Louie:
I will have Linx placed at end of September.
I am scared of vagus nerve injury, possible pleural complications and future erosion of device... Please help me clarify risks and help me understand the safety of this procedure short and long term
Pray for me. Thanks.
8/29/2014 7:49:29 PM
Brian E. Louie, MD
Robecca, at the moment, I don't think anyone is offering a LINX to a patient who has had a prior Nissen fundoplication. I would clarify with your surgeon that this is in fact the plan. While it may work, I have some concerns about adding a LINX to a Nissen. I am not aware that this has been done.

If your fundoplication has failed, you could talk to your surgeon about having the repair revised without a LINX device.
8/6/2014 2:47:30 PM
I had an open Nissen about 15 years ago. It really did great up to about 3 years ago. I have been taken meds daily and now they don't help with the heart burn, chest pain, feeling as if I have something in my throat. I go in two weeks for the Bravo pH test. Just to verify it is reflux again. My Dr. talked to me about the Linx procedure but also said he will have to research to see if I would qualify. He did explain that he would have to repair the Nissen, it has deteriorated during the procedure if I qualify for it. In your opinion do you believe I would qualify for the procedure?

8/4/2014 1:35:05 PM
Brian E. Louie, MD
Zeppo, You are likely experience GERD but are completely unaware of the fact that it is occurring. GERD should be thought of in terms of three areas: 1) Symptoms; 2) Endoscopic findings; and 3) Degree of acid exposure. Some patients have very little acid, lots of symptoms and normal endoscopies. Others have no symptoms, endoscopic findings and moderate acid. You would fit into the later group.

You have identified the challenges in treating you. You could take medication (PPIs) but not know whether they are working for you since you have no symptoms to gage the response. You could have surgery (LINX or Nissen) but the same applies - we won't know if surgery is working either without testing you.

I'd first consider getting a pH test off the medication and seeing how much reflux you have. Then you need to decide do you want any treatment, PPIs or surgery. Then, test you after with pH testing to see if your reflux is controlled.
8/4/2014 10:04:23 AM
Brian E. Louie, MD
Dot, the only concern I know about is the MRI and this issue hopefully will be settled by the FDA later this year. It should allow LINX patients to undergo an MRI if the machine is 1.5 tesla or less which is what most machines are ‎and provide good images
7/28/2014 10:03:20 AM
Brian E. Louie, MD

As I mentioned in the previous post on burping, this is a difficult situation. It is even more difficult in a situation if pH test is normal despite the 100% symptom correlation.

It is very clear from the data that patients do best with surgery if they have an abnormal pH test, classic symptoms (heartburn and regurgitation) and improve with PPI treatment. So, to consider implanting a LINX becomes a challenge but it is not impossible.

Based on what you say, you have a sensitive esophagus (since your pH test is normal) and you have learned to burp to alleviate the sensations with the belching. Even if a LINX is placed you have learned this behavior of burping and it may not change after the device is placed because you've learned to compensate. Often, I'll have patients see the psychologist to retrain their brain to not focus on the sensation and to not burp.

This is a complicated decision and you should seek consultation with an experienced esophageal surgeon.
7/28/2014 10:02:49 AM
Zeppo Levy
I have never had any heartburn or pain. My symptoms have been belching and very rare occasions of active reflux that reaches my mouth, which I have stopped completely by not eating late at night.

However, I have had two upper endoscopies that show repeated acid burns that are not healing due to repeat exposure.... that I am COMPLETELY unaware of.

1) Any idea what is going on? Is this GERD or something else?
2) Because I have NO awareness of the problem (no pain, no heartburn) I have no way of knowing if the PPI is working, or how much to take. My only metric is another endoscopy. My sense is to treat the cause, (e.g LINX) rather than take meds without even knowing if they are working.

Your thoughts would be much appreciated.
7/27/2014 11:12:37 PM
Dr. Louie,

I also have the same burping problem and this does correlate with PH drops on my PH manometry. There was a 100 % symptom association,however my demeester score is normal. My LES pressures are also very low. Would you offer me a linx procedure?
7/26/2014 12:32:30 PM
Certain operations, procedures eg: MRI, cannot be done following LINX implantation. Is this accurate?
7/23/2014 11:53:34 AM
Brian E. Louie, MD
The symptom of burping is a difficult one because it is not a symptom of GERD. It is a side effect of GERD and occurs because patients swallow air when they are swallowing the reflux or trying to swallow saliva to neutralize the acid. This becomes a habit and gets the patient into a cycle which is difficult to stop.

If the burping can be tracked with pH testing to coincide when acid is up in the esophagus, this symptom usually improves. If you have a Nissen, the burping will stop but you will pass a lot of flatulence because the air you swallow has to go somewhere. The LINX will control the reflux but you may still belch. In some cases, the patients are so used to burping they cannot stop even when the reflux is controlled. Here a psychologist who knows hypnotherapy is often helpful to retrain the brain to not focus on the belching.
7/15/2014 10:23:38 AM
I have had a problem with constant BURPING for almost 8 months. I have had 4 test, the last of which was a esophageal manometry. This last test showed that there was a problem with my LES being weak. I have tried many PPI's and am still burping. I am strongly considering the Linx procedure or the Nissen. I had 2 endoscopies done in 2013 and have a small hiatal hernia. Other symptoms include clearing of throat but the most bothersome thing is the constant BURPING! Will either of these surgeries stop the burping?
7/13/2014 2:13:13 PM
Brian E. Louie, MD

Obviously, I can't tell you what to do. But, from your post, I can make several observations.

First, remember if you have antireflux surgery of any sort, you will be off Dexilant and your gastric acidity should return to normal. It's low now because of the medication and makes you susceptible.

Second, there is no perfect antireflux surgery. LINX is about as close as it comes. Nearly all of the LINX patients can vomit normally so I wouldn't think that's going to be an issue for you. The sensations from LINX after having it placed almost always resolve by 3 months after the procedure.

Third, EndoStim should be available in the US in late 2014 but only through clinical trial at selected centers in the US. Stay tuned for that announcement. It does seem promising and we are hopeful that we will be selected as a center for the trial.

I suggest that you sit down with a surgeon who has experience with the both fundoplication and LINX to educate more in person. You may wish to wait until Endostim is release to hear more about that as well before making a decision.
6/30/2014 9:09:47 AM
Hi Dr. Louie,

I am taking Dexilant, 60 mg, QD for two years.

My reflux is under control (barely) and I am very susceptible to gastric infections like food poisoning, due to a low acid level in my stomach, so dining out is a crap shoot.

The EndoStim seems to have much promise, but it is not FDA approved in the USA. The Linx "scares" me a bit, since there is a certain amount of force to open the LES and I don't want to feel uncomfortable, like food getting stuck in my chest. The Nissen is a non-discussion due to the side effects of the surgery.

What should I do? Am I missing something?

6/20/2014 10:30:13 AM
Brian E. Louie, MD
Ernesto, It does sound like you would be a great candidate for LINX.

I can't speak for your surgeon. I would ask the surgeon his or her plan. I would assess your hernia at surgery‎ and make a decision on whether to close the hernia. Often it is not needed. Regardless the goal is place the Linx below the diaphragm .

I always place the device inside the posterior vagus nerve because I think it helps keep the device next to the LES.

Good luck.
6/19/2014 12:23:29 PM
Hello there! I am seriously considering LINX. I just had an upper endoscopy and it revealed a small hiatal hernia (1.5 to 2 cms). Everything else is fine such as e. manometry, upper GI series, etc. It means I qualify for linx. My big question is about prevention of device migration. Do you think the surgeon will pull down the small hiatal hernia together with the LES (lower esophageal sphincter) below my diaphragm first then he will snug/tighter the diaphragm hiatus with a mesh or something to move the location of LES from above the diaphragm to under the diaphragm? This way, the LINX device will be implanted below the diaphragm instead of above the diaphragm. Does this make any sense? Thanks so much! Hope to hear from you. :) thanks so much for creating this blog.
6/17/2014 8:22:38 PM
Brian E. Louie, MD
David, The short answer is that placement of LINX has not been attempttd after a prior repair. You may wish to look back in the blog comments for both LINX blog posts where we had several dialogues about the reasons for not doing this. I would suggest that you see an experienced esophageal surgeon and be re evaluated to determine your options including revision of the previous repair.
6/12/2014 5:32:46 PM
David Turner
I had surgery for a hiatal hernia about 18 yrs. ago. The wrap has come undone and I am back on meds. could this procedure help with my acid reflux.
6/5/2014 1:21:40 PM
Brian E. Louie, MD

I’m sorry that your 3 year old has to suffer with this so early in life. Unfortunately, there is no research on the LINX in anyone under 18 years of age. There is so much growing to do between 3 and 18 that there is no way to even consider implanting a device since it would need to change as your child changes.

I recently spoke at a symposium on GERD and one of the other speakers was a pediatric surgeon who specialized in childhood GERD. She was making the point that GERD at 3 is very different that GERD in adulthood. It requires very careful decision making not so much because of the inability to belch and vomit, but because a lot of children as they grow older will “out grow” the reflux.

Seeing the surgeon is reasonable to hear what their opinion is. You don’t have to agree to surgery but you should her what they have to say. Clearly, you’ll want to know that the surgeon has an interest in pediatric GERD.
5/19/2014 1:42:58 PM
Brian E. Louie, MD

The decision to place a LINX in your situation will depend on the surgeon. At Swedish, we would make the decision based on several factors. First, how normal is your motility test since this is important to supporting a LINX device. Second, how much Barrett’s you have. If you have a 1 cm or so and a normal esophagus, your could support of LINX. If you have long segment Barrett’s (5 cm or greater) and a poorly functioning esophagus then a LINX may not be a good idea.

It would be best to see an experienced LINX surgeon and have your studies reviewed to make a decision about LINX
5/19/2014 1:42:24 PM
Is there any research on the pediatric use of LINX? My 3-year old has been on PPI's for almost 6 months now and still experiences reflux after every meal. The pH level of the reflux is controlled by the PPI, but the episodes continue to occur. Our GI specialist has recommended a consultation with a surgeon regarding Nissen fundoplication, but I do not like the idea of preventing his ability to belch and/or vomit for the rest of his life.
Thank You
5/15/2014 1:12:26 PM
David Rosado
Hello, I have had gerd for many years and I have a week les with a small hiatal hernia and have been diagnosed with barrets with no dysplasia. Since they have now approved the use of an MRI with the linx installed is it still possible to have it done with my barretts?
5/13/2014 10:15:28 PM
Brian E. Louie, MD
Yes, you are a candidate.
5/13/2014 5:29:25 PM
I have had a partial gastrectomy due to cancer 6 years ago. I do not have les. Is this procedure still an option?
5/9/2014 9:24:59 PM

Am i still a candidate for Linx if i had erosive esophagitis (grad B by LA classification) ?
5/7/2014 8:37:30 AM
Lee Trujillo
I have been treated for Barretts for well over 15 yrs, my medication works but I am a long time patient.
5/6/2014 9:40:50 PM
4/16/2014 12:09:46 AM
Brian E. Louie, MD
Leslie, I think that your candidacy for LINX will heavily depend on your gastroparesis. You should have studies to determine how severe your gastroparesis is. It's likely that your bloating symptoms are from the gastroparesis as is your reflux. LINX will help with your reflux but won't help the gastroparesis and you are likely to have ongoing symptoms. From what you tell me, your best to make sure the treatment you get treats both. In that case, a Nissen is likely to be better if you have moderate gastroparesis since the Nissen will help your stomach empty.

It sounds like you are seeing a gastroenterologist and not a surgeon. I'm not sure if that is correct, but your situation is more complicated than a patient with no gastroparesis. You may wish to see both a surgeon and gastroenterologist to get several opinions.
4/7/2014 4:07:54 PM
Brian E. Louie, MD

Thanks for your post. Your story is very similar to many patients with GERD. They start on PPIs and feel improved. Overtime, they have more symptoms and undergoing an increase in the dose of PPIs. It sounds like you'd be a great candidate for LINX. I would not classify us as "still working" on the LINX. I think we have a very good idea of who will benefit.

I think your worries over Barrett's and cancer are real to you. The numbers would suggest that your risk is really small. These reasons should not be your primary reason for deciding about surgery for reflux. At the moment, the key would be better control of symptoms and reflux control. Both Nissen and LINX would be suitable alternatives.

I suggest you go back to your surgeon for more discussion. If you are not comfortable with the surgeon, then seek one you are comfortable with.
4/7/2014 4:07:23 PM
Joanne Taravella
I am interested in the LINX surgery.
I read PPI's don't stop the progression of GERD.
Also I read that they don't prevent Barrets or cancer.
I went to a surgeon last year to see if I was a candidate
for the LINX and he told me to keep taking PPI's for now
because there still working for the most part.
I have had GERD for many years now and I have to take
these PPI meds.every, and this year I am noticing breakthrough symptoms more and had to go up on my dose.
My fear is that I will get Barrets or worse and won't be able to get the LINX.
The surgeon said to come back in a year.
He also told me that I seem like the nevous type and would worry alot after the opetation about the device inside me.
I worry now anyway so what's the difference.
He mentioned having a nissen and I am hesitant about it because of what I read and heard.
4/4/2014 8:13:42 PM
Leslie Mercer
I have gerd esophagitis and gastroparesis with frequent belching.Would I still be a candidate? Is there much gastointestinal bloating from the Linx?I'm being following by GI who does Linx and has "scheduled" me to see him on April 20.
4/4/2014 1:03:58 PM
Brian E. Louie, MD
3/5/2014 3:35:26 PM
Wondering how many of this procedure Swedish has performed to date.
3/5/2014 3:14:24 PM
Kevin Owens
I had a Nissen in 2006 that is in a failure mode. A recent endoscopy showed light from the stomach escaping around the device shaft. I hate to think of having a repeat Nissen surgery every 8-10 years. Can I have LINX surgery this time around and reverse the previous Nissen and expect more longevity out of the Linx?
3/5/2014 11:44:42 AM
Would this be an option for people with Bile reflux?
2/26/2014 2:26:18 PM
Brian E. Louie, MD
Yes, very exciting.

there has not been much research on the satisfaction of LPR patients with LINX. there was one study looking at patients with atypical symptoms for which LPR fits into that category. Patients did benefit but it was not designed specifically for LPR.

In our own experience the LPR patients do very well, but its not perfect. However, it may be more suitable than a Nissen for most LPR patients who don't have severe GERD symptoms as well.
2/24/2014 10:28:16 AM
This is very exciting news!

Has there been much research on the satisfaction of LPR patients with the Linx procedure?
2/14/2014 6:18:09 AM
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