Comparative Results for the TIF Procedure vs. Traditional Anti-Reflux Surgery Techniques
Gastroesophageal Reflux Disease (GERD or Acid Reflux)
Gastroesophageal reflux disease (GERD) is a condition in which food refluxes (travels backwards) from the stomach to the esophagus (the swallowing pipe). This action can irritate the esophagus, causing heartburn and other symptoms. The symptoms can include belching, coughing, difficulty swallowing, nausea and vomiting, regurgitation, sore throat, hoarseness, and chest pain to name a few. In severe cases, the reflux may lead to damage of the lower part of the esophagus know as Barrett's esophagus.
While not completely understood, it is believed that in most patients gastroesophageal reflux disease (GERD) is caused by a problem with the lower esophageal sphincter (LES) muscle, a group of muscle fibers that exists at the lowest portion of the esophagus as it enters the stomach. It is thought that because this sphincter does not close completely, food and acid may reflux back from the stomach to the esophagus.
Treatment for GERD comes in many forms. For minor cases, lifestyle changes and common medications are often the best course of action. More serious issues may require surgical treatment. Dr. Snyder employs cutting edge techniques and procedures to ensure patient safety and a speedy recovery.
The treatment options for gastroesophageal reflux disease (GERD) fall into three broad categories: conservative, medications, and surgical.
Conservative methods include changing lifestyle and eating behaviors that contribute to acid reflux.
Medication therapy uses both over-the-counter and prescription medications to reduce the production of acid in the stomach, protect the esophagus from acid damage, and help keep pressure at the esophageal junction low.
Surgical intervention is necessary when other methods of controlling GERD fail.
Lifestyle and diet change are the first steps in reducing the frequency and severity of heartburn and GERD-related symptoms. These changes focus on food choices, modifying intake, and taking steps to reduce pressure within the stomach.
Control alcohol and tobacco use: Tobacco and alcohol irritate the esophagus and act on the lower esophageal sphincter (LES) to reduce its ability to stay closed.
Reduce trigger foods: Foods that stimulate acid production or relax the LES are called “trigger foods.” Eliminating these foods from your diet can alleviate many symptoms of GERD.
Adjust medications: Prescription and non-prescription medications change acidity, LES pressure, and stomach emptying. Review medications with your doctor to ensure they are not making your GERD worse.
Get active: Activity helps gastric emptying and assists with weight control. Reducing your weight by as little as 10 pounds can have a dramatic effect on stomach pressure and prevent reflux through the LES.
Stay upright: Reclining increases the pressure of stomach contents on the LES and promotes reflux, especially when your stomach is full. Staying upright for a minimum of 2 hours after eating can reduce symptoms.
Adjust sleeping position: Raising the head of your bed about 6 inches using blocks under the front legs can decrease pressure on the LES while you sleep, reducing nighttime heartburn.
Loosen clothing: Tight-fitting clothes such as pants, belts, and back support belts increase abdominal pressure and make it more difficult for the LES to do its job. In many cases, weight gain is responsible for tight-fitting clothing, so weight loss can help tremendously.
Medications for Reflux
Both over-the-counter and prescription medication have been the mainstay of GERD treatment for many years. Medications are designed to reduce symptoms by reducing stomach pressure, decreasing stomach acid production, and protecting the esophagus from acid damage. Because GERD is a progressive disease, however, medication doses will adjust upward as a reflux disease worsens.
Types of Medications
Antacids: Reducing stomach acidity with over-the-counter antacids is the most frequent remedy for infrequent and mild heartburn.
H2 Blockers: Histamine turns on acid production at a cellular level in the stomach. Histamine blockers are frequently used to stop acid production as part of stomach ulcer treatment. Reducing stomach acid production also reduces the severity of acid reflux symptoms.
Proton Pump Inhibitors (PPIs): More powerful than H2 blockers, PPIs reduce acid production in the stomach by up to 80%. They have quickly become the most important class of drugs used in GERD treatment and are usually part of a lifelong drug therapy regimen to control chronic acid reflux. There could be potential side effects to long term use.
Coating Agents: These types of prescription drugs protect damaged tissue in the stomach and esophagus from exposure to acid, reduce pain, and allow damaged tissues to heal.
Motility-promoting drugs: Improving the rate at which stomach contents empty into the intestines with motility drugs can reduce stomach pressure and prevent reflux through the LES.
Surgical Treatment for Reflux Disease
Minimally invasive surgery has increased the popularity of surgery as a long-term solution for chronic GERD. Surgical intervention focuses on strengthening the lower esophageal sphincter, correcting hiatal hernias, and in some cases, helping obese patients reduce their weight.
Surgical repair of the LES is considered when:
Conservative and medication-based therapies are ineffective at controlling GERD symptoms
Complications are developing from GERD, despite medication treatment
Atypical symptoms such as asthma, sinus problems and chronic cough are uncontrolled
GERD medication side effects are not tolerated by the patient
Lifelong therapy with medications is cost prohibitive or too disruptive to the patient’s lifestyle
Dr. Brad Snyder is proud to perform the revolutionary TIF Esophyx procedure. A typical EsophyX TIF procedure takes only 30 to 40 minutes to reconstruct the anti-reflux barrier and strengthen the LES. In most cases, patients are in the hospital for just one day and can return to normal activities within a few days after the procedure. Come learn more about TIF in one of our FREE seminars! Click here!
Causes of Reflux Disease
There are several factors that can combine to increase the likelihood that you will suffer from this condition or that will increase the severity of your acid reflux disease symptoms:
Increased stomach pressure: This may be due to overeating or from conditions that alter stomach contractions and emptying.
Acidic Foods: Some foods increase the acidity or the amount of acid produced by the stomach. These foods include alcohol, acidic juices, tomato products, peppermints, chocolate, and soda.
Medications: Certain medications can affect stomach acid production and gastric motility or can interfere with the normal opening and closing of the LES.
Smoking: Makes reflux worse and causes peptic ulcers, esophagitis, and gastritis.
Hiatal Hernia: A hiatal or diaphragmatic hernia often accompanies gastroesophageal disease. The region of the muscular diaphragm through which the esophagus passes may enlarge and allow part of the stomach to move up through it. This alters the pressure at the end of the esophagus and allows reflux to occur.
Obesity: Stomach pressure increases with abdominal girth. As stomach pressure increases, it becomes more difficult for the LES to prevent reflux.
Nerve and muscle abnormalities: Opening and closing of the LES relies on normal muscular function and nerve conduction
Benefits and Risks of Surgery
For patients who experience inadequate symptom control, severe regurgitation or side effects from medication, surgical intervention may be appropriate.
The most common anti-reflux surgery is known as a fundoplication. The primary benefit of all fundoplication procedures is the ability to treat reflux via anatomic reconstruction of the anti-reflux barrier. Rather than suppress acid as with medical therapy, anti-reflux surgery aims to eliminate abnormal acid exposure by restoring the anatomic structures that naturally prevent abnormal reflux.
The advantages of laparoscopic surgery include a shorter recovery time, reduced postoperative pain, and a faster return to work, with elimination of heartburn in about 85% of patients. Surgery is also highly effective at curing GERD-induced asthmatic or respiratory symptoms. It may also enhance stomach emptying, and it improves peristalsis in about half of patients. Another benefit for surgical patients is the ability to stop taking GERD medications, possibly for life.
Incisionless Surgery (TIF)
An incisionless approach is also available for patients with smaller hiatal hernias. This procedure, called Transoral Incisionless Fundoplication (TIF), is performed through the mouth with no abdominal incisions and patients typically return to work in less than a week. Associated complications, which usually resolve within a few weeks of surgery, are typically lower than for laparoscopic procedures.
To date, TIF surgeries have an excellent safety profile. TIF has been performed in over 10,245 cases worldwide with no associated mortalities. Clinical studies demonstrate that TIF patients do not experience long-term complications commonly associated with conventional anti-reflux surgery such as chronic dysphagia (trouble swallowing), gas bloat syndrome, and increased flatulence.