Swedish News Blog

Different treatment options for acid reflux

Ralph W. Aye, MD, FACS

Ralph W. Aye, MD, FACS
Thoracic and Esophageal Surgeon

Gastroesophageal reflux disease (GERD) is the most common disorder of the upper gastrointestinal track, affecting nearly 40% of the American population.  Antisecretory medications such as omeprazole are the mainstay of treatment, but 40% of patients have incomplete control of symptoms.  While surgical repair (fundoplication) is highly effective, only 1% of patients have an operation, leaving a large group of individuals incompletely treated.

The Stretta procedure is another option to treat GERD. 

Research on LINX recently published

Brian E. Louie, MD

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

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.

Updates on LINX - GERD reflux management system

Brian E. Louie, MD

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 ...

Troubles swallowing food or liquids – what does it mean?

Leslie H. Price, MD

Leslie H. Price, MD
Gastroenterologist

Dysphagia refers to the sensation of food or liquid being delayed or hindered from the mouth to the stomach.  This abnormality is increasingly recognized as an important concern that requires attention and study.  There are many causes of impaired swallowing, which are categorized into two types, mechanical, a structural barrier to food bolus movement, and motility disorders, involving abnormal muscle movement.  There are also two major anatomical sites, oropharyngeal and esophageal. 
 
Oropharyngeal dysphagia is related to problems with the initiation of the swallows and clearing the food bolus from the mouth to the esophagus.  This usually occurs within a second of swallowing and you may feel that you cannot initiate a swallow or food hangs up in the neck region.  A test that is commonly used to evaluate this is a modified barium swallow or videofluoroscopic swallowing study.  This study provides critical information on inability or excessive delay in initiation of swallowing, unintentional inhalation of food, unintentional expulsion of food from the nose or mouth, and/or abnormal retention of food in the back of the throat after swallowing.  Most ...

Surgical treatment options for GERD

Ralph W. Aye, MD, FACS

Ralph W. Aye, MD, FACS
Thoracic and Esophageal Surgeon

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 ...

Dysphagia and Stroke

Annie Sanford, RN, BSN

Annie Sanford, RN, BSN
Stroke Clinical Effectiveness Coordinator

Gulp! 

Dysphagia (difficulty swallowing) is a common challenge for stroke survivors.  Up to 78% of stroke patients will experience some degree of dysphagia with those patients being 7 times more likely to develop aspiration pneumonia.  Aspiration occurs when, instead of being swallowed, food or beverages are inhaled into the lungs.  This can lead to pneumonia and possibly death. 

It is vital to follow....

Preventing progression of Barrett's esophagus to cancer without surgery

Drew Schembre, MD, FASGE, FACG

Drew Schembre, MD, FASGE, FACG
Medical Director, Swedish Gastroenterology

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:

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