A study published this month in the journal Archives of Surgery finds that two rarely-used nonsurgical treatments can help people with the symptoms of acid reflux disease, including heartburn. The treatments could help alleviate symptoms in patients who are not helped by acid-reducing drugs.

Gastroesophageal reflux disease or GERD is a relatively common chronic condition in which the contents of the stomach, including the corrosive stomach acid, seep up into the esophagus, irritating its lining and causing inflammation. This usually causes severe, persistent heartburn and it may also cause difficulty swallowing, voice hoarseness, and chronic coughing.

The study examined the use of two “endoluminal therapies” that do not involve incisions but instead use an endoscope, a long flexible instrument inserted through the mouth and down the esophagus. The first, known as full-thickness plication, involves using an endoscope to tighten the junction between the esophagus and the stomach with sutures. The other procedure, called radiofrequency therapy, delivers energy waves to the muscles of the esophagus and stomach to improve the function of the valve between the two organs. 

In the study, the researchers treated 126 GERD patients using one of the two nonsurgical techniques between 2002 and 2006. A total of 58 underwent full-thickness plication and 68 patients underwent radiofrequency treatment. After six months, among the patients who underwent full-thickness plication, the percentage of patients with moderate to severe heartburn decreased from 53 percent to 43 percent and many patients saw improvements in voice symptoms and swallowing difficulties. Among the group receiving radiofrequency treatment, moderate to severe heartburn decreased from 55 percent to 22 percent and decreases were also seen for swallowing difficulties, voice symptoms, and cough. Both groups reported using less much less medication after the treatments.

The most common treatments for GERD are a class of acid blocking medications called proton pump inhibitors. While effective for some, these medications do not work for everyone and they can be expensive. GERD returns in more than 80 percent of cases after people stop taking these medications.

Surgical options have been available since the 1990s, but these are seen as a treatment of last resort due to their invasiveness, cost, and questionable effectiveness. The most commonly used surgery, laparoscopic fundoplication, involves wrapping the top portion of the stomach around the base of the esophagus to strengthen the junction between the two organs.

The two nonsurgical treatments have been available for more than ten years but are still uncommon in part because health insurance companies typically do not pay for them.

If you have GERD symptoms that are not helped by medication or if you have “breakthrough” symptoms several times a week, you may want to talk to your healthcare provider about the nonsurgical options. If you want a more specialized medical opinion, the American College of Gastroenterology has a physician locator to help you find a GI specialist in your area.

For more information about treating GERD, join the conversation at the Healia Health Community for Acid Reflux.

_{Photo: tomsaint11, Flickr, Creative Commons}