Comparing Two Non- Pharmacological GERD (Gastroesophageal Reflux Disease) Treatments

According to an article published in Archives of Surgery, two non-pharmacological GERD (gastroesophageal reflux disease) treatments seem to be effective in lowering medication use and improving swallowing symptoms as well as the patient's voice. One of the assessed therapies appears to be effective in reducing heartburn and cough. The other one reduces regurgitation.

Archives of Surgery is a JAMA/Archives journal.

The authors explain that GERD is a condition in which stomach acid backs up into the esophagus. It is generally treated first with medication, such as proton pump inhibitors. However, compliance (adherence is often a problem) - patients may not take the medication exactly as instructed over the long-term. Consequently, GERD returns in over 80% of cases when medication is discontinued.

Since the 1990s surgical options have also been available for GERD patients, and more recently endoluminal therapies that involve entering through the patient's body's natural passages to repair and underlying GERD causes.

Full-thickness placation is one endoluminal therapy. It involves using an endoscope - a long narrow tool - to tighten the junction between the esophagus and the stomach with sutures.

Another is called radiofrequency therapy. This delivers energy waves to the esophagus and stomach muscles. It is said to improve the function of the valve between the esophagus and the stomach.

Louis O. Jeansonne IV, M.D., then of Emory University School of Medicine, Atlanta, and now at Ochsner Medical Center, Baton Rouge, La., and team looked at the effectiveness of the two therapies in 126 GERD patients between 2002-2006.

Up to 2004 only radiofrequency was available. As from 2004 treatment decisions were based on what the patient preferred, as well as the surgeon's judgment and anatomical factors. 58 patients underwent full-thickness placation, while 68 underwent radiofrequency. Patients then reported their medication use and rated their GERD symptoms before and after their procedure.

Follow-up data was gathered for 51% of the patients six months after the procedure. Moderate to severe heartburn has dropped from 55% to 22% among those who had undergone radiofrequency. Medication use had dropped to 50% from 84% - swallowing difficulties, voice symptoms and cough also improved. For those who had received full-thickness placation, moderate to severe heartburn has dropped to 43% from 53%, medication use had fallen to 43% from 95%, and patients experienced significant improvements in their voice symptoms, swallowing and regurgitation.

Neither group experienced any changes in chest pain or asthma symptoms.

The authors concluded "Our experience indicates that radiofrequency and full-thickness placation are both effective, providing symptomatic relief and reduction in proton pump inhibitor use. For patients whose chief complaint is regurgitation, full-thickness plication may be the preferred procedure. Further study is needed to determine the long-term effectiveness of endoluminal treatments."

"Endoluminal Full-Thickness Plication and Radiofrequency Treatments for GERD - An Outcomes Comparison"
Louis O. Jeansonne IV, MD; Brent C. White, MD; Vien Nguyen, MD; Syed M. Jafri, BS; Vickie Swafford, RN; Mina Katchooi, DDS; Leena Khaitan, MD, PhD; S. Scott Davis, MD; C. Daniel Smith, MD; Shahriar Sedghi, MD; Edward Lin, DO
Arch Surg. 2009;144(1):19-24.