New procedure gives reflux relief for many patients

From Press Reports

 

Elwanda Walker endured test after test and tried medication upon medication before finding relief from chronic reflux in a new procedure done exclusively in this region at North Mississippi Medical Center.

Reflux, also called gastroesophageal reflux disease or GERD, happens when food or liquid leaks backward from the stomach into the esophagus. This action can irritate the esophagus, causing heartburn and other symptoms.

“The problem with reflux is that the lower esophageal sphincter, the muscle at the bottom of the esophagus and the entrance to the stomach, becomes weak,” explains Sam Pace, M.D., a board-certified gastroenterologist with Digestive Health Specialists in Tupelo. “Basically, the gate that is supposed to open to let food in and close to keep it from coming back out becomes dysfunctional.” Left untreated, reflux can lead to serious complications such as esophagitis, stricture, Barrett’s esophagus and esophageal cancer.

“I had really bad reflux and nothing was working for it,” says the 65-year-old Tupelo resident. “I could take a bite of food and my stomach would start to hurt, then I’d have to take a swig of medicine. The simple fact was, no matter what I tried to eat or drink, it wouldn’t go down and then it would come back up.”

Time for a Change

After Walker’s husband passed away in 2008, she became even more isolated. “I couldn’t go eat with my family or participate in barbecues,” she says. “I couldn’t go eat with my church friends because I didn’t want to get sick in front of people.”

Walker was almost at her wit’s end when she was referred to Tupelo surgeon David Gilliland, M.D., with Surgery Associates, P.A. “I was miserable. I had no quality of life,” she says. “I said ‘please tell me that I’m not going to die from this.’ I was almost bedridden because I was so sick at my stomach.”

Until now, physicians had only two options for treating reflux-with medication or with a surgical procedure called laparoscopic Nissen fundoplication, widely used since the early 1990s. In this procedure, the top part of the stomach (fundus) is wrapped around the lower esophagus to improve the reflux barrier. While Nissen fundoplication can be effective, it has drawbacks.

“After a patient has fundoplication, he can no longer belch or vomit,” Dr. Gilliliand says. “Some patients report gas bloating because of this.”

A Better Option

Dr. Gilliland told Walker about the LINX Reflux Management System, a new device approved by the U.S. Food and Drug Administration.

“The device is a string of very small magnets enclosed in titanium beads,” he explains. “When placed around the outside of the esophagus, the magnetic attraction between the beads helps the sphincter stay closed to prevent reflux.” The force of swallowing breaks the magnetic bond to allow food and liquid to pass through, then the magnetic attraction closes the lower esophageal sphincter back to form a barrier.

“The LINX device is dynamic, helping the lower esophageal sphincter open and close,” Dr. Pace says. “It mimics the muscle and how the muscle is supposed to work. Patients can still belch and vomit, so bloating isn’t an issue.” While the Nissen procedure is permanent and involves significant alterations to the anatomy, the LINX procedure is merely supportive and can be removed if necessary.

“It was amazing from the first day,” Walker says. “When I woke up, I expected to be sore and my throat to be swollen, but all I had was a little tenderness in my stomach. I didn’t even take a pain pill. Immediately I could drink water, which I had not been able to do before without it coming back up.” She spent one night in the hospital and was able to return to normal activities within a week.

Like Nissen fundoplication, the procedure is done laparoscopically through five small punctures in the abdomen. “Once we are in the operating room, we can decide which procedure the patient is better suited for, depending on anatomy” Dr. Gilliland says. “The LINX procedure cannot be done if the patient has a hiatal hernia larger than 3 centimeters.”

No More Pain

Another benefit is a quicker return to solid food. “We try to get LINX patients to eat regular food right away to train the device,” Dr. Gilliland says. “With the Nissen procedure, they are on a prescribed diet for at least two weeks.”

Before the procedure, Walker was taking medicine for irritable bowel syndrome five times a day, plus medicine for indigestion and pain. “Now I rarely have to take something, only if I’ve eaten something that doesn’t agree with me,” she says. “And I can eat pizza again. I hadn’t had pizza in years!”

Dr. Gilliland and Robert McAuley, M.D., both began performing in 2012 as part of a select group to launch the procedure nationwide.

 

Outside of Tupelo, the closest facility offering the LINX procedure is in Atlanta.

“It’s the most amazing thing that has happened to me. When I went back to see Dr. Gilliland after the procedure, I asked if I could hug him,” she says. “He saved my life. I had no quality of life.”