GERD study on the cutting edge of gastroenterology - August 22, 2014

Courtesy of NWI Times

August 22, 2014 9:35 am   •   Jennifer Pallay

The staff at the Methodist Hospital GERD Center hopes that patients are finding permanent relief after having an incision free procedure the hospital introduced four years ago.

A new study began this summer and will follow patients who have the Transoral Incisionless Fundoplication, or TIF, procedure as well as a hiatal hernia repair procedure. Patient quality of life will be assessed six months and a year post surgery.

Peter Mavrelis, one of the gastroenterologists involved in the study, says their goals are to prove and document good results over a wide range of patients.

The study, which began June 5, includes 19 patients ages 23 to 76. Thirteen of them are women.

“This is our own local study to document that by repairing the hiatal hernia first, followed then by TIF procedure that we’re getting good clinical results and that patients do not need to take medications following this procedure.”

The incisionless procedure is done through the mouth and makes a new valve at the end of the patient’s esophagus to prevent regurgitation.

Cathy Reed, of Portage, was one of Mavrelis’ patients and says she hopes the study will find positive outcomes like hers.

Reed, 60, had acid reflux since she was born. She would feel acid in her lungs that would make her choke and suffered from frequent coughing. She took Nexium for 20 years and tried every over-the-counter medication and home remedy out there, she says.

“Mount Olive brand Kosher pickle juice was my go to,” she says.

Even with daily medication, her reflux was out of control. She had difficulty sleeping and her health struggles affected her family life.

“If you suffer from acid reflux, I’d definitely check this procedure out,” she says. Her procedure was done in January 2013 at Methodist Hospital in Merrillville and she stayed overnight. “It was a life changer. Immediately after surgery, there was no reflux and I haven’t had any since. You put up with a little bit of recovery but you’re off the medications for life.”

Recovery included a limited diet at first and slowly reintroducing foods.

“You can’t eat meat, you can’t bread, you can’t eat any raw vegetables at all until at least six to eight weeks out.”

Patients also must avoid lifting because of incisions.

Reed says the procedure is amazing and came after “a lot of years of prayer. I praise the Lord they have come up with this to help people. No more pills, no more acid reflux. Hopefully it holds forever but we’ll see.”

Another benefit is that her frequent upper respiratory problems have lessened. They are now easier to manage and are more short lived.

Although Reed’s procedure was done before the quality of life study began, she says she hopes it has good findings.

“I’m one of the top five percent of the 85 percent who have good results,” she says. “But it’s a permanent solution to a horrible problem.”

Mavrelis says that Reed had the combination procedure where doctors first repaired her hiatal hernia and then performed the TIF procedure to correct her GERD.

Doing both repairs at the same time helped correct her problem, says Mavrelis, whose practice, Internal Medicine Associates, has a co-management agreement with Methodist.

Candidates for the TIF procedure must have documented regurgitation of acid as a cause for their problem. They have to be able to undergo general anesthesia and are typically 18 and older.

Methodist Hospital has two new pieces of equipment to help pick the right patients for this procedure.

The tests also help diagnose other conditions that can cause symptoms of trouble swallowing and chest pain.

“Not everybody with heartburn has GERD,” Mavrelis says.

The main reason patients elect to have the TIF procedure are side effects like osteoporosis, which can come from the long term use of proton pump inhibiting drugs used to treat heartburn.

“The medications for GERD are fairly safe but sometimes taking them over a long period of time can have side effects,” Mavrelis says.

Because osteoporosis is more common in women, they should try to avoid the long term use of these drugs, he says.

“This operation might give them an alternative way to manage their heartburn and GERD symptoms.”

Mavrelis says 20 to 30 percent of Americans have one or more episodes of GERD per week and that “if you do get heartburn, you should be evaluated by family doctor and possibly have further testing to find out how severe the problem is.

“Most people can self medicate with over-the-counter medicines but if it’s a persistent problem, that’s when further testing should be considered.”

The risks of the TIF procedure include those of undergoing general anesthesia and possible bleeding or esophageal injuries, though those are small risks, Mavrelis says.

Kathleen Korman, Nurse Navigator for the GERD Center of Methodist Hospitals, is helping Mavrelis with the quality of life study by explaining it to patients, collecting data and tabulating the results.

“A lot of patients have this procedure because their heartburn is not getting any better with medication,” she says. “Are their heartburn symptoms lessened after the procedure and one year out?”

They will also collect data on if the procedure decreases medication side effects.

“It will be interesting to see the results,” she says.