This is very exciting news!Has there been much research on the satisfaction of LPR patients with the Linx procedure?
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.
Would this be an option for people with Bile reflux?
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?
Wondering how many of this procedure Swedish has performed to date.
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.
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 candidatefor the LINX and he told me to keep taking PPI's for nowbecause 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.
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.
Joanne, 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.
I HAD THE LINX PROCEDURE ABOUT 7 WEEKS AGO AND I WAS VERY HAPPY UNTIL LAST WEEK WHEN I BEGAN FEELING THAT BURNING SENSATION AGAIN. IT'S NOT AS BAD BUT I WONDER IF WHAT COMES NEXT? I WILL SEE MY DOCTOR SOON BUT DOES ANYONE KNOW WHAT THE NEXT STEP MIGHT BE?
I have been treated for Barretts for well over 15 yrs, my medication works but I am a long time patient.
Hello!Am i still a candidate for Linx if i had erosive esophagitis (grad B by LA classification) ?
I have had a partial gastrectomy due to cancer 6 years ago. I do not have les. Is this procedure still an option?
Alexandra,Yes, you are a candidate.
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?
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
David,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
Laura,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.
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.
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.
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.
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.
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?Thanks.
Brian,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 r...
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?
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.
Certain operations, procedures eg: MRI, cannot be done following LINX implantation. Is this accurate?
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?
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.
Jon,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.
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
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.
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?Thanks,
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.
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 termPray for me. Thanks.
Tonie,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...
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.
Cheryl,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 experienci...
Halito, 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
How many Linx have been removed and a Nissen done immediately during the same procedure.
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
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.
Hello,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?Thanks,Paul
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.
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
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.
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.
Jack, 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.
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.
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.
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.
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.
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.