Healthbeat Report: Heartburn Relief

October 28, 2010 (CHICAGO)

There are medications that can help control the symptoms of reflux. They're called proton pump inhibitors but don't work for everyone. And now there is some concern about long-term use and bone health. Patients are hoping for a permanent, safe and easy fix and a newer procedure could be the answer.

Elvira Cairo's story is a familiar one. Her heartburn started out as a nuisance and then got so bad it was ruining her life.

"It was very hard because I grew up on Italian food," said Cairo. "I had to switch to bland food and I just don't like bland food...sometimes I bent over with the pain it was horrible. I had it really bad."

She had more than a routine case of GERD, also known as gastroesophageal reflux disease. It's caused when the valve between the esophagus and the stomach isn't working right, allowing acid to flow upward and causing heartburn and indigestion.

Over time Cairo needed more and more medication. So when doctors at West Suburban Medical Center in Oak Park suggested an alternative approach to fix the underlying problem she was game.

"You don't burn any bridges with this operation because there are no incisions there is very little recovery and people don't feel a lot of pain," said Dr. Fredrick Tiesenga, Surgeon, West Suburban Medical Center.

The surgery is called transoral incisionless fundoplication or TIF. With specialized equipment surgeons go through the mouth nd down to the esophagus and stomach to reshape the weak valve using existing tissue. The surgery uses a device called the esophyx. It's based on the gold standard in reflux surgery called fundoplication which has proven to be very successful over the years.

Proponents of this endoscopic technique say there is no visible scarring and it carries less risk of infection or discomfort and a quicker recovery. For younger patients who don't want to be on medication the rest of their life, its appealing.

"It creates a permanent valve and permanent change and it doesn't go away," said Dr. Tiesenga.

There have been similar promises before about long term fixes with other minimally invasive methods, but most didn't work. Experts say part of the problem is an area of the body is not just delicate. It's very dynamic and restoring the original anatomy is tricky.

"The caveat is 50-percent of these people may be back on some type of reflux medication within five years. So the operation doesn't always last forever," said Dr. John Pandolfino, gastroenterologist, Northwestern Memorial Hospital.

At Northwestern Memorial Hospital, doctors are optimistic about this latest approach, but are not yet convinced about the durability.

Esophyx is FDA approved, but some clinics across the county will keep track of results with company funded research.

"The FDA wants us to keep tabs on this they want us to evaluate this and they want us to be more rigorous than we were in the past," said Dr. Pandolfino.

It's been about nine months since Elvira Cairo had the procedure. The misery of heartburn, for now, is in the past.

"I would say 95-percent's a wonderful feeling," said Cairo.

The procedure has been around for several years and more hospitals now offer it. Still, some doctors say it will take time before they know if it lasts as long as the gold standard surgery. According to the manufacturer of Esophyx, most insurance companies cover the cost.

Experts remind patients that the first step in controlling GERD should be lifestyle modifications such as losing weight, propping up your mattress and keeping a food diary.

West Suburban Medical Center

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