BMN Blog

NOV 23

Gastroesophageal Reflux Disease (GERD) Awareness Week occurs annually around the week of Thanksgiving and is intended to increase awareness about GERD and its potential health risks when left undiagnosed or untreated, potential adverse effects of long-term proton pump inhibitor (PPI) medication use, and the links between chronic heartburn and adenocarcinoma, the most common type of esophageal cancer in the U.S.

Chronic heartburn/acid reflux, or GERD results when the gastroesophageal valve allows stomach contents to wash backward or reflux into the esophagus, causing injury to the esophageal lining. Approximately one in five American adults have GERD as it is the most common gastrointestinal-related diagnosis made by physicians during clinical visits and a primary risk factor associated with esophageal cancer.

Many patients are diagnosed with GERD and not fully satisfied with their current treatment options. They often present with daily heartburn and regurgitation or other atypical symptoms such as chronic cough, hoarseness, chronic sinus or lung infections, and dental erosions. Until recently, patients only had two choices—a lifetime dependence on daily medications (and often incomplete symptom control) or the risks and long-term side-effects of traditional surgery.

PPI medications offer safe and effective short-term relief for heartburn symptoms. Unfortunately, even while on medications for years, many patients are still unable to eat the foods they want or must sleep sitting up to reduce nighttime reflux, and these patients frequently become dissatisfied with lifestyle adjustments. 

Healthcare providers who treat acid reflux report that GERD can be complex to fully diagnose and treat and can often require an array of advanced treatment options to comprehensively manage patients. Furthermore, GERD is an anatomical problem that needs an anatomical solution - medications like PPIs may temporarily relieve heartburn symptoms, but they don’t solve the underlying anatomical problem or prevent further disease progression.

The Transoral Incisionless Fundoplication (TIF) procedure is an effective option for the anatomical problem. The TIF® 2.0 procedure allows physicians to effectively treat the root cause of moderate to severe GERD and fills the treatment gap between pharmacological therapy and more traditional surgical options. 

More than 25,000 TIF procedures have been performed worldwide since 2007. Additionally, there are over 140 peer-reviewed publications in respected gastroenterology and surgical journals including randomized controlled trials with sham control arms. 

The TIF procedure isn’t just a treatment option for the most severe cases that would have traditionally required a Nissen fundoplication; it has become a preferred option for patients with moderate to severe GERD. Additionally, the TIF procedure is designed to treat GERD symptoms while minimizing post-operative side effects such as dysphagia, gas bloat, and flatulence.

The TIF procedure is a data-backed solution for moderate to severe GERD patients who are:

  • Dissatisfied with pharmaceutical therapies and the burdensome lifestyle changes (sleeping positions, strictly timed eating, etc.) that they are forced to manage symptoms
  • Suffering from non-acid symptoms of reflux such as asthma, persistent cough or sore throat
  • Frustrated with progressively increasing dosages of their reflux medications that may or may not be controlling symptoms
  • Concerned about the potential long-term side effects from dependence on proton pump inhibitors

Indications for the TIF procedure include patients presenting with a dysfunctional antireflux valve, including those with a hiatal hernia. For those patients presenting with both GERD and a hiatal hernia measuring >2cm, laparoscopic hiatal hernia repair may be performed immediately prior to the endoscopic TIF procedure. The hiatal hernia repair plus TIF procedure can be performed in the same anesthesia setting should patient anatomy dictate repair of both a hernia and the antireflux valve.

Raj Parikh, MD is a gastroenterologist in practice with Birmingham Gastroenterology.

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