Tuesday, June 19, 2018
Health

Patients seek reflux relief in a surgically implanted ring of beads

TAMPA — For more than 20 years, Victor Alonso put up with gastric reflux. The heartburn, chronic coughing, worrying about what and when he could eat, the daily medication that didn't really help. The rare possibility that the medication might cover up symptoms of a serious consequence of reflux — esophageal cancer.

Last year, Alonso, 50, decided he wanted a permanent solution. His doctor told him about the gold standard surgery known as Nissen fundoplication, a decades-old procedure that can have a better than 90 percent success rate. But when Alonso found out that recovery could take several months and there was a possibility of side effects such as bloating, he looked for other options.

That's when he read about the LINX Reflux Management System, a ring of magnetic beads that helps keep the opening between the lower esophagus and the stomach closed, so stomach acid can't back up and cause painful heartburn and other symptoms including sinusitis, bloating, chronic coughing, chest pain and hoarseness.

More than 15 million Americans have the constellation of heartburn and other symptoms known as gastroesophageal reflux disease, or GERD, according to the American College of Gastroenterology. GERD has been increasing over the past 10 to 15 years, right along with the obesity epidemic.

But you don't have to be overweight to have GERD. Some other lifestyle factors that contribute include: eating greasy, spicy, acidic foods, eating too close to bedtime, drinking alcohol and smoking.

For some, losing weight and changing their habits is enough to solve the problem. Others turn to medications such as antacids or H2 blockers such as Zantac. Longer-term relief often is found in a class of drugs called proton pump inhibitors (such as Prilosec) that can relieve symptoms and heal the esophageal lining. But studies show people who take these medications long term or in high doses may be prone to some bone fractures.

Patients develop reflux symptoms when the normally tight muscle between the lower esophagus and stomach becomes weak and loose, allowing stomach acid to splash up into the esophagus. The LINX device is surgically placed around that junction. The magnetic beads are forced apart by swallowing, burping or vomiting, but otherwise keep the pathway closed.

The device received FDA approval in 2012 and is implanted under general anesthesia. The procedure usually takes about an hour and requires a 24-hour hospital stay.

Alonso, a driver for UPS, had the surgery in November and was able to reintroduce many of his favorite foods right away. "I even tried orange juice and went right to bed, without a pillow wedge. And I had no reflux at all. I couldn't believe it," he said.

Not everyone is enthusiastic.

Dr. Joel Richter, director of the division of digestive diseases at USF Health and a gastroenterologist, said he thinks it's too early to recommend LINX without reservation.

"There's no long-term data yet on this," Richter said. "We don't know the effect of this surgery 10, 20 years out. The Nissen fundoplication has been around since the '40s. We know it works."

In that procedure, part of the stomach is wrapped around and sewn to the lower portion of the esophagus to strengthen the opening and keep stomach acid out of the esophagus. Its success relies more heavily on the surgeon's skill, and a small percentage of patients aren't happy with their outcomes.

"They can be left with difficulty swallowing, very uncomfortable bloating, and some will have diarrhea," said Alonso's surgeon, Gopal Sai Grandhige, who began offering LINX at Memorial Hospital of Tampa last year.

Grandhige likes the LINX because it's an implant and, when used in appropriate patients, the results are more likely to be consistent. He also thinks it's a good option for younger patients who don't like the idea of taking medication for the rest of their lives.

Dr. Vic Velanovich, professor of surgery and director of the division of general surgery at USF Health, decided to begin offering LINX at Tampa General Hospital. "Patients are coming to us asking for it," he said. "I think there's a role for LINX in a small subset of patients who have mild reflux symptoms who want to get off medications, and those who have concerns about the side effects of Nissen surgery."

Doctors agree that the LINX won't replace the Nissen surgery, but it adds to the options now available to patients.

Three months after his LINX surgery, Alonso must still eat slowly and always have a beverage to help swallow dry foods like chicken breast and bread, a common side effect that is supposed to improve over time.

"I'd rather have that any day than have reflux," he said. "People don't realize how horrible it is."

Irene Maher can be reached at [email protected]

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