Help for heartburn

Endoscopic surgery may eliminate the need for risky drugs

Kathy Halsey suffered foot and arm bone fractures while taking GERD medications. However, after a nonsurgical procedure, she was able to go off the drugs.

About five years ago Kathy Halsey, a school administrator, decided she had to do something about the nagging chronic heartburn and reflux that had plagued her for years.

“The burning and pain would happen all day, making it hard to work. I had to eat right before any meeting and take drugs every day just to get my job done, and I would still have unbearable burning, and then headaches associated with acid reflux. At night, I had to sleep sitting up. My quality of life was severely reduced.”

Officially Halsey had gastroesophageal reflux disease, or GERD, a painful condition whereby stomach acid or stomach content flows back into the esophagus. GERD, which is more common as we age, is usually due to a faulty sphincter valve between the stomach and esophagus.

But doing something about her case of GERD proved more challenging than Halsey expected. Over the years, the most common medications to treat the condition, proton pump inhibitors (PPIs), have been linked to a growing list of serious side effects, such as pneumonia, kidney disease, bone fractures and dementia. And recently several studies have found that people taking PPIs are at increased risk for heart attack, stroke and renal failure, possibly because the lining of cardiovascular blood vessels is impaired by the drugs.

Those side effects make it more important than ever for patients to consider alternative treatments for GERD, including a number of options offered by UCI Health experts, using endoscopy, a nonsurgical technique that accesses the digestive tract through the mouth.

“Because we’re learning so much about the possible negative side effects of long-term use of PPIs, I see a dramatic shift away from people taking those drugs and toward getting these sorts of endoscopic treatments,” says Dr. Kenneth Chang, director of the UCI Health H.H. Chao Comprehensive Digestive Disease Center (CDDC) and a leading specialist in GERD, Barrett’s esophagus and endoscopic surgery to treat digestive disease.

But many patients, like Halsey, try over-the-counter PPIs first. She didn’t smoke, didn’t drink excessively, changed her diet and controlled her weight — all first-line lifestyle treatments for GERD. But absolutely nothing stopped the reflux. Then tests revealed she had Barrett’s esophagus, a precancerous condition often associated with chronic GERD.

“That’s when it all got very serious,” Halsey says. She was advised by her gastroenterologist to take various prescription PPIs, such as Dexilant™, Nexium™, Prevacid™ and Prilosec™. Prescription PPIs are more potent than the over-the-counter versions. The medications have become so common that nearly 16 percent of adults ages 55 to 64 take them; only cardiac and cholesterol drugs are more common. For some patients, the medication benefits still outweigh the risks. For Halsey, however, PPIs weren’t a good solution.

“For three years I worked with my first gastroenterologist, taking different prescription medications to stop the acid, I also started breaking bones,” says Halsey, who fractured both her foot and arm. “I’d never broken a bone in my entire life, so of course I was really concerned.”

The next step for her would’ve been an invasive surgery to treat the esophagus and the faulty valve. Her gastroenterologist told her that the only doctor in Southern California who could help her with other options was Dr. Chang.

“Kathy was the perfect candidate for an EsophyX TIF™ procedure, which is something that we offer here but isn’t available yet in many places,” says Chang. An EsophyX TIF™ — which stands for transoral incisionless fundoplication — is a surgery performed using a special scope and camera inserted through the mouth. First, in a separate procedure, Chang removed Halsey’s precancerous cells. After restoring the cells to normal, he treated the underlying GERD with the EsophyX TIF™ procedure, restoring proper function by elongating the esophagus and tightening the sphincter valve to keep stomach acid from splashing up.

An EsophyX TIF™ is done under anesthesia and takes only about an hour. Patients spend one night in the hospital and resume work and other activities in a couple of days. About 75 percent of these patients no longer need PPIs.

CDDC physicians also offer other techniques to treat various types of GERD. The LINX procedure involves endoscopically implanting a special magnetic ring around the esophagus, just above the stomach. The magnetic ring strengthens the function of the sphincter. Swallowing breaks the magnetic bond so food and liquid pass normally into the stomach. After swallowing, magnetic attraction brings the beads back together to prevent stomach acid and contents from splashing back into the esophagus.

A procedure called Stretta™ involves endoscopically administering radiofrequency energy to a patient’s sphincter to bulk it up and increase its effectiveness. “Stretta is ideal for people with a rather mild form of GERD, usually those who only have reflux during the day,” says Chang. These procedures, like the EsophyX TIF™, allow patients to drastically reduce or, more often, totally eliminate medications.

Another new minimally invasive GERD treatment to reinforce the sphincter is called MUSE™, which stands for the Medigus Ultrasonic Surgical Endostapler. The system utilizes a single instrument that’s inserted through the mouth to allow surgeons to repair the sphincter. The procedure, performed under general anesthesia, takes about 60 to 90 minutes and provides relief from GERD.

“To me, the EsophyX™ procedure was a miracle,” says Halsey, who now has no battles with reflux and instead enjoys traveling, Pilates classes and meditation. “Here was a condition I suffered with for so many years and I had taken all those medications. Dr. Chang basically fixed it with this minimally invasive procedure. Dr. Chang gave me back my quality of life and, more importantly, saved my life.”

Learn more about treatments for gastroesophageal reflux disease at ucirvinehealth.org/aboutgerd.

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— UCI Health Marketing & Communications
Featured in UCI Health Live Well Magazine Fall 2016