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GERD Surgery Is Better Than Taking More Drugs

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Many people don’t get enough relief from gastroesophageal reflux disease (GERD) by taking drugs—even the powerful drugs called proton pump inhibitors (PPIs). At the same time, these people rightly worry about the serious side effects of taking even more drugs. The solution may not be more medication, but rather the outpatient surgery called magnetic sphincter augmentation (MSA). That might sound like a drastic solution, but a new study on the six-year-old treatment shows that it has a good safety record—and corrects the problem once and for all.

Heartburn is the most talked about symptom of GERD, but it’s by far not the only one. Regurgitation, which feels like a wet, burning burp in your throat or mouth every time it happens, occurs frequently with some patients and can be even worse than heartburn.

Both symptoms are caused by stomach acid creeping up from the stomach into the esophagus due to a weak and leaky lower esophageal sphincter (LES), a valve that’s supposed to keep acid in the stomach where it belongs. While PPI drugs can reduce the amount of stomach acid and ease heartburn, they don’t fix a leaky LES, and frequently regurgitating even small amounts of acid is still uncomfortable. Worse still, it can over time lead to Barrett’s esophagus, precancerous changes in the cells of the esophagus, which can, in turn, lead to esophageal cancer.

Though the MSA procedure was FDA-approved in 2012, most doctors are still treating moderate-to-severe regurgitation by doubling the typical PPI dose, even though that doesn’t help most GERD patients.

However, the new study on MSA may have more doctors suggesting it to their patients. An analysis of the procedure from 21 medical centers found that regurgitation stopped in 89% of patients…and so did their heartburn, so they no longer needed to take any PPI medication.

The surgery involves placing a device—basically a bracelet of titanium magnetic beads with the brand name LINX—around the LES. The magnets keep the valve closed when you’re not eating or drinking but allow it to open when you are.

Because it’s a minimally invasive, laparoscopic procedure—four or five small incisions in the abdomen—most MSA patients can return to normal activities within a few days. The most common side effect is temporary difficulty swallowing (dysphagia), but this can often be avoided by following post-surgery guidelines to eat only one or two spoonfuls of food during every waking hour for the first few weeks. A rare (less than 1%) complication is erosion of the esophagus from the device, which requires removing it.

There are now about 150 surgical centers around the country doing the procedure. Surgeons who are most likely to be experienced in MSA are esophageal surgical specialists. One way to find one near you is to enter your zip code at the website of the company that makes the magnetic device, Torax Medical.

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Source: Reginald C.W. Bell, MD, founder and director of the Institute of Esophageal and Reflux Surgery in Englewood, Colorado, assistant clinical professor of surgery at University of Colorado Health Sciences Center in Denver, and lead author of the study “Laparoscopic Magnetic Sphincter Augmentation versus Double-Dose Proton Pump Inhibitors for Management of Moderate-to-Severe Regurgitation in GERD: A Randomized Controlled Trial,” published in Gastrointestinal Endoscopy. Dr. Bell had the MSA procedure himself three years ago. Date: October 29, 2018 Publication: Bottom Line Health
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