February 15, 2010
Hospital offers incisionless acid reflux treatment
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Bolingbrook – Adventist Bolingbrook Hospital now offers an incision-less treatment for chronic acid reflux disease. The procedure, known as Transoral Incisionless Fundoplication (TIF), is performed through the mouth and reconstructs the barrier between the stomach and esophagus to prevent stomach fluids from refluxing up into the esophagus. It typically takes less than one hour and most patients go home the next day and can return to work and most normal activities immediately.
Twenty-one million people, or more than 7 percent of the U.S. population, suffer from acid reflux, also known as Gastroesophageal Reflux Disease (GERD). Forty percent of U.S. adults experience GERD symptoms – most frequently, heartburn – at least once a month.
Among them was 55-year-old Chicago resident Gary Cygan, who was Adventist Bolingbrook Hospital’s first TIF patient. After taking acid reflux medication for years, Cygan researched other options online and discovered TIF. He was treated by gastroenterologist Dr. Kamran Ayub and general surgeon Dr. Vafa Shayani on Jan. 8 and was amazed at the simplicity of the procedure and how quickly he returned to his normal routine.
“I drove myself home from the hospital and I went back to work three days later,” Cygan said. “I was told to take it easy with food for awhile, but a week later I had a pizza and I was fine.”
Before TIF was available, patients had only three options for treating acid reflux: lifestyle modifications, medication, and a surgical procedure that involved wrapping the upper part of the stomach around the esophagus to prevent stomach acid from moving upward. That procedure may be performed either through a traditional surgical incision or using the video-assisted technique (laparoscopy). In both cases, patients experience substantial pain at the incision site and often have to wait several days or weeks before engaging in normal activities and returning to work.
TIF requires no incisions. While under general anesthesia, the flexible EsophyX device is lowered through the mouth into the stomach under the visualization of an endoscope “video” placed down the shaft of the device. Once inside the stomach, the surgeon manipulates the device to create a tight valve by pulling the esophagus into the upper portion of the stomach and holding it in place using suture-like fasteners. Following the procedure, 85 percent of patients remain symptom-free after three years.
“I still recommend surgical fundoplication for patients with very bad reflux or a large hiatal hernia, one that is larger than three centimeters,” Ayub said, “but I suggest TIF to many of my other patients. It improves their quality of life and I’m excited about its success.”
Occasional heartburn needs minimal treatment, including lifestyle modifications such as avoiding trigger foods like citrus and caffeine and eating small meals – especially close to bedtime – and taking over-the-counter medication.
Most individuals do not seek medical advice until heartburn interferes with their daily life. Even then, prescription medications are effective at relieving acid reflux. These include H2 blockers and the stronger, proton pump inhibiters (PPIs). The first decreases acid production; the second virtually eliminates its release.
However, long-term results with medical management are not as promising, especially after patients reach the maximum doses of available medications. Symptoms often recur, and, in the case of PPIs, medications often tamper with calcium metabolism/absorption, increasing the risk of osteoporosis. That’s when doctors recommend surgery, but even then, acid reflux can return, necessitating a second operation. As with other surgical procedures, redo fundoplication is much more challenging to perform.
“With TIF, there is no cutting of any sort, so there is less trauma to the patient and their bodies, and there are minimal physiologic adjustments to be made as a result of the procedure,” Shayani said. “Patients love the results.”