Unlike medications, these same-day procedures address the root cause of chronic acid reflux.
“I couldn't lie down without feeling the pain. Some nights I’d wake up in the middle of the night and I was choking on acid. I’d aspirate it and it felt like my lungs were on fire,” said Melissa A.,* 43, describing how chronic acid reflux used to control her life.
Even as a child, Melissa used to tell her mom it felt like there was burning orange juice in her throat. But it wasn’t until her early 20s that Melissa was diagnosed with a severe case of gastroesophageal reflux disease (GERD). “My doctor was shocked that I had reflux even when I was standing up,” she said.
What is GERD and how is it linked to cancer risk?
The esophagus is the “food pipe” connecting the mouth to the stomach. At the bottom of the esophagus is a band of muscle called the lower esophageal sphincter (LES) that acts as a valve. When a person swallows, the valve relaxes to allow food and liquid into the stomach, then closes again.
If the LES weakens or doesn’t function properly, stomach acid can escape into the esophagus, causing symptoms like heartburn and regurgitation (acid or bile in the throat). It’s usually worse after eating or when lying down. When acid reflux happens frequently, it can lead to GERD.
One serious complication of GERD is Barrett’s esophagus, in which the cells lining the esophagus change and thicken. This condition is considered precancerous and must be monitored regularly to determine if further treatment is needed.
Melissa was in her late 20s and living in Boston when she first got “scoped” for her GERD. During the upper endoscopy exam, her doctor saw a large section of damaged tissue and diagnosed her with Barrett’s esophagus.
“The treatment I’ve always gotten is ‘take your medicine, get scoped every year, and just cross your fingers that it doesn’t turn into anything worse,’” Melissa said.
And then she had kids.
“I wanted something to change,” Melissa said. Although she knew that the chances of developing cancer from Barrett’s esophagus were low, it felt like she had a ticking time bomb.
A comprehensive treatment plan
In her late 30s, Melissa was living in Princeton and raising her family. She had a new gastroenterologist managing her health, Anish Sheth, MD, chief of gastroenterology at Penn Medicine Princeton Health.
In addition to GERD and Barrett’s esophagus, Melissa had a hiatal hernia, which meant part of her stomach was pushing through the diaphragm into her chest.
Sheth, who is board certified in gastroenterology, explained that most hiatal hernias are small enough that they don’t require treatment, but Melissa’s was large and likely what weakened her LES valve.
GERD can typically be controlled with dietary and lifestyle changes, along with medications to reduce stomach acid. But Melissa didn’t fit the profile of the typical patient with GERD (male, middle-aged, overweight).
Although she’d managed her GERD with medication for years, “mine was so severe that I didn’t feel like I was completely symptom-free, even on the medicine,” she said.
Sheth and his team wanted to take a comprehensive approach and manage Melissa’s symptoms, fix her hernia, and decrease her risk of esophageal cancer. They began with diagnostic testing to better understand the severity of her reflux and why it was happening.
“An endoscopy is part of that, but it’s also assessing reflux with pH monitoring and manometry testing, which measures the muscle function of the esophagus,” Sheth said.
After thorough testing, Sheth determined medication alone was not enough to help Melissa improve; however, she was an excellent candidate for the TIF procedure.
Proven treatments TIF and LINX provide long-term relief
Melissa needed surgery to repair her hiatal hernia and pull the stomach back into its proper location. Her esophageal valve also needed to be fixed. Sheth considered two available options:
· LINX—a surgical procedure in which a circular device (LINX) is implanted at the base of the esophagus. Magnets keep the valve closed and swallowing opens it.
· TIF (transoral incisionless fundoplication)—an endoscopic procedure in which the top part of the stomach is folded and secured around the lower esophagus to create a tighter valve.
Because testing showed Melissa had weak muscles in her esophagus, Sheth recommended the TIF procedure.
“The LINX tightens up the valve area a little bit more, so people with weak esophageal muscles can have trouble swallowing after the procedure,” he said. The TIF would make it easier to swallow while still providing a barrier to reflux.
Melissa had a hybrid procedure at Penn Medicine Princeton Medical Center. First,
Nisha S. Dhir, MD, who is board certified in general surgery, repaired the hernia. Next, Monica Saumoy, MD, MS, who is board certified in gastroenterology, performed the TIF procedure.
Once Melissa was fully recovered, Sheth began treating the Barrett’s esophagus with radiofrequency ablation (RFA), using high-energy radio waves to destroy the precancerous cells. RFA is most effective when reflux is controlled.
With the damaged parts of her esophagus now gone, Melissa feels like a weight has been lifted.
As for the success of her TIF procedure, Melissa said, “It has literally changed my life. I used to sleep propped up and don’t have to anymore. And I stopped taking medicine entirely after I healed.”
Sheth said LINX and TIF are both outpatient procedures that have been around for more than a decade, with long-term studies that prove they’re safe and effective at addressing the root cause of reflux.
So effective that Melissa confessed she rarely thinks about GERD anymore.
To find a Penn Medicine Princeton Health provider, please call 800-789-7366 or visit pennmedicine.org/providers.
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*Name changed for privacy.