The Swedish Thoracic Surgery team recently had results from a study published in Annals of Thoracic Surgery, "Short-Term Outcomes Using Magnetic Sphincter Augmentation Versus Nissen Fundoplication for Medically Resistant Gastroesophageal Reflux Disease", in which a retrospective case-control study was performed of consecutive patients undergoing either procedure who had chronic gastrointestinal esophageal disease (GERD) and a hiatal hernia of less than 3 cm. Based on the study, the LINX device appears to restore the sphincter barrier function and preserve normal physiology which enables belching and vomiting.
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.
- 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.
- For patients with non-medicare insurance, the ...
You may frequently interchange the terms heartburn, acid reflux and GERD, but it’s important to know if your heartburn is chronic and recurring. Heartburn is a symptom we experience when acid from the stomach passes up through the esophageal sphincter into the esophagus, known as acid reflux. For some people this can be acid that passes only a few inches up the esophagus or all the way to the mouth. When acid from your stomach comes up as high as your mouth, you run the risk of aspiration (when fluids either going down to your stomach or coming up from your stomach enters your trachea and into your lungs).
Gastroesophageal reflux disease (GERD) is described as severe or chronic acid reflux. Severe means that it happens when we have had a change in our body, like a pregnancy that causes pressure on our stomach forcing stomach content up into the esophagus. Chronic may mean there is a mechanical problem like a weak esophageal sphincter or a hiatal hernia that allows leakage into the esophagus.
Whether intermittent, severe or chronic, acid reflux can feel miserable if it is not controlled and it can also cause cancer. We all suffer from heartburn from time to time, but when heartburn happens regularly or does not resolve with lifestyle or diet changes you may need to seek the assistance of a physician who can help you resolve it. Thankfully over the last 20 years, physicians’ ability to diagnose and treat these conditions has benefited by some excellent technology.
The first step to ...
Gastroesophageal reflux disease (GERD) is the most common disorder of the upper gastrointestinal track. It's estimated that up to 40% of Americans take some form of anti-acid medication at least once a month, making it one of the most commonly used types of medication in the world.
Heartburn is simply a burning sensation behind the breast bone, and is not necessarily from GERD. It can be caused by a variety of other disorders, including heart disease, musculoskeletal disorders, and disorders of other parts of the gastrointestinal track, including the stomach, pancreas, gall bladder, liver, or intestine A simple way to differentiate GERD from heartburn is to take antacids or over the counter acid suppressants. There are two classes of acid suppressants: H2 blockers like ranitidine/zantac; and proton pump inhibitors (PPIs) like prilosec/omeprazole. If the symptom partially or completely responds, it is likely caused by stomach acid, particularly GERD.
How is GERD managed?
GERD is rarely life-threatening and can generally be managed symptomatically. Some may ...
Many people wonder what the treatment for Barrett's Esophagus (BE) is. Treatment for BE without dysplasia consists primarily of controlling esophageal acid exposure, usually with once a day proton pump inhibitor (PPI) medications like omeprazole (Prilosec®). Occasionally, twice a day dosing or even anti-reflux surgery may be necessary to completely control acid reflux. Unfortunately, suppressing acid does not usually cause the Barrett’s tissue to regress or even prevent it from progressing to cancer.
If dysplasia is found on any biopsies, treatment recommendations change:
- Low-grade dysplasia: Close surveillance with endoscopy every 6-12 months or ablation.
- High-grade dysplasia: Endoscopic therapy to destroy Barrett’s tissue or surgery.
- Early cancer: Endoscopic removal of focal cancer followed by tissue destruction or surgery
Experiments performed 20 years ago showed that in most people, once the Barrett’s tissue has been removed or destroyed, normal squamous tissue tends to regrow in the area as long as acid reflux is suppressed.
Endoscopic tissue destruction can be performed many ways:
Heartburn (which was once considered an annoying result of over-eating) has matured into a full-blown medical condition better known as gastro-esophageal reflux or GERD.
GERD, or the sensation of acid or other gastric fluids washing up into the chest or mouth, affects as many as 1 in 5 adults in the US on a monthly basis with up to 6% experiencing symptoms 2 or more times per week. Estimates suggest that about 5% of those who suffer from reflux will develop a potentially pre-malignant condition called Barrett’s esophagus (BE). Named after the British thoracic surgeon who erroneously suggested the condition resulted from a congenitally short esophagus, BE is characterized by “specialized intestinal lining” replacing normal squamous epithelium (ie, wet skin, like the lining of the mouth) in the lower esophagus in response to long-term, repetitive exposure to stomach acid.
While this may seem like a protective adaptation—Barrett’s tissue will not ulcerate and develop scarring the way squamous tissue does—it is inherently unstable and can progress to cancer. The risk for developing adenocarcinoma of the esophagus for people with BE is more than 30 times greater than for people without it.
Luckily, the absolute risk of progression from BE to cancer is relatively low. BE progresses to esophageal cancer at the rate of around 0.2% per year. Further, cancer doesn’t usually develop suddenly. Instead, it progresses through a series of stages termed “dysplasia” meaning bad or unfavorable changes that can be identified on biopsies collected at endoscopy. These changes progress from...