A new minimally invasive procedure is offering relief for people with chronic reflux.
The Linx procedure addresses the root cause of reflux – the weakened muscle between the stomach and esophagus that allows food, stomach acid and other liquids to leak back up into the esophagus.
“The device is a string of very small magnets enclosed in titanium beads,” said Tupelo surgeon Dr. David Gilliland. “When placed around the outside of the esophagus, the magnetic attraction between the beads helps the sphincter stay closed to prevent reflux.”
Swallowing is strong enough to push the magnets apart, but normal stomach pressure can’t.
Since October, Gilliland and Tupelo surgeon Dr. Robert McAuley have done about a dozen Linx procedures at North Mississippi Medical Center-Tupelo. They are currently the only two Mississippi surgeons approved in the procedure, which gained FDA approval in March. In the United States and Europe, the procedure has been performed more than 1,000 times.
The laparoscopic procedure is a significant advancement for gastro-esophageal reflux disease, also known as GERD.
Anatomy of heartburn
Most people focus on the chronic heartburn that comes with GERD because that’s what hurts. But at its core, the condition goes back to the muscle between the esophagus and stomach.
“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,” said Tupelo gastroenterologist, Dr. Sam Pace. “Basically, the gate that is supposed to open to let food in and close to keep it from coming back out becomes dysfunctional.”
If reflux is left untreated, it can lead to serious problems, creating scar tissue that can narrow the esophagus or a pre-cancerous condition called Barrett’s esophagus.
In addition to lifestyle changes, the first line of treatment is medications that reduce the acid in the stomach, particularly proton pump inhibitors, like Nexium and Prilosec. Those medicines generally work for many people, but about 35 percent will have their heartburn controlled, but not their reflux, Pace said.
“Medicine stops the acid, but it doesn’t stop the reflux,” Pace said. “It doesn’t do anything to help the muscle.”
These folks still feel food and liquid sloshing around in the bottom of their esophagus, Pace said. Some even wake up coughing or choking at night.
Since the 1990s, surgeons have used a procedure called the laparoscopic Nissen fundoplication. The stomach is wrapped around the lower esophagus to improve the reflux barrier. It can be effective, but it has some drawbacks.
The Nissen is not reversible, and patients can no longer belch or vomit, which can cause uncomfortable bloating. Patients who have the procedure are limited to a special diet for at least two weeks while the stomach heals.
The Linx procedure preserves the ability to belch and vomit and is reversible; patients begin eating solid food again within a day of surgery. However, it cannot be performed if the patient has a hiatal hernia greater than 3 centimeters.
In a study published in the New England Journal of Medicine, Linx patients were followed for three years after surgery. Severe regurgitation was eliminated in all the patients and nearly all – 93 percent – had a significant decrease in medications.
“The Nissen isn’t standardized,” which may account for variations in its effectiveness, McAuley noted. “The Linx uses a standard technique; it’s put in the same way with every person.”
None of the studies to date have shown any problems with the titanium beads eroding, but there is not yet 10 years of data.
Insurance coverage varies; some insurers still classify the procedure as investigational.
RETURN to pizza
Elwanda Walker battled extensive heartburn for years. She even stopped going out to eat with family and friends because she never knew when she would get sick.
“I lived on mashed potatoes,” Walker said. “It was a battle.”
Over the past two years, her condition intensified despite the medication.
“I couldn’t drink water,” Walker said. “I had just about given up on quality of life.”
Walker had the Linx procedure done in October, and it was liberating for her. She stayed in the hospital overnight, and like all Linx patients, worked on exercising the band of titanium beads helping the muscle between her esophagus and stomach close.
“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,” Walker said. “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.”
Since then she’s been able to eat anything that strikes her.
I can eat pizza again. I hadn’t had pizza in years!” Walker said.
Michaela Gibson Morris/NEMS Daily Journal