Millions of Americans suffer from heartburn.
They live with pain behind their breastbone or regurgitation and spend millions of dollars trying to control their symptoms with over-the-counter antacids and pharmaceuticals.
What most patients don’t understand is that the medications only help to treat the symptoms of gastroesophageal reflux disease – GERD – but they do nothing for the actual mechanical problem that is allowing the reflux to occur.
Heartburn is caused by a weak lower esophageal sphincter that allows harmful gastric fluid from the stomach to reflux into the esophagus. Medications help neutralize the acid, lessening the pain, but reflux and ongoing damage to the esophagus persists.
“Patients have limited understanding of the disease. Most of them think that the medicine is actually taking care of the problem, instead of just masking the symptoms,’’ said Jenifer Marks, MD, a thoracic surgeon at UCHealth Colorado Springs (Memorial Hospital). “They are still refluxing; it’s just that the pain is improved because the actual material coming back up is not acidic.’’
Marks said when patients understand they still have reflux, which can continue to damage the esophagus, or they simply do not want to take the medications long term, some look for surgical options. Marks is among the first surgeons in Colorado to offer a new surgical treatment for GERD called the LINX procedure.
The LINX device is a small ring of magnetized titanium beads that is laparoscopically implanted around the lower esophageal sphincter and helps to augment its function. With a LINX device in place, the sphincter opens during a normal swallow, but normal intragastric pressure is not enough to open the device and allow reflux. The device, which looks like a small linked bracelet, is designed to help the sphincter stay closed to prevent reflux but is designed to open with increased intragastric pressure associated with belching, or if the patient needs to vomit.
The device is about the size of a quarter and is implanted during a standard minimally invasive laparoscopic procedure.
“The surgery is for people who have GERD and are not happy with their symptom control on medication, and that’s an enormous number of people,’’ Marks said.
Approved by the FDA in early 2012, the implant has been used in Europe for many years. The recent push to allow more medical centers in the United States to implant LINX came after the publication of a five-year safety and efficacy data from multiple centers in the United States. At five years, the study showed:
- 85 percent of patients were free from daily dependence on acid-suppression medications.
- Bothersome heartburn was reduced to 11.9 percent from 89 percent at baseline.
- Bothersome regurgitation was reduced to 1.2 percent from 57 percent at baseline.
“That’s really unheard of in terms of any of the prior treatment we’ve had for reflux,’’ Marks said of the study.
Patients are potentially eligible for surgery if they’ve had reflux and are not satisfied with their symptom control on medications or if they are interested in an alternative to a life-long medication.
Patients who opt for a LINX consultation with Dr. Marks will have a series of tests performed to ensure they are a good candidate for the device.
“We want to see all of the patients who are interested in the device, regardless of what they have had done, because we would like to talk to them about their disease and what’s happening,’’ Marks said.
While the procedure has proven successful in a large number of patients, at this time insurance approval for the procedure comes on a case-by-case basis. A patient-advocate company works closely with Marks and her staff to ensure the insurance appeal process goes as smoothly as possible.
If the insurance company ultimately will not cover the surgery, Marks said, the hospital is working on a self-pay option for the procedure.