Gastro Esophageal Reflux Disease or GERD affects nearly 40% of the US population. Currently, the standard of care for treatment of acid reflux is either medication, with a class of drugs called proton pump inhibitors (like Prilosec), or a surgical procedure called Nissen Fundoplication. Both the proton pump inhibitors and the Nissen procedure are extremely effective in treating GERD, with acid normalizing in >90% of patients.
At my practice in Plano TX, I have had several patients ask me about a new procedure called Transoral Fundoplication also referred to as the TIF procedure for acid reflux. For this procedure, a device is passed through the mouth, into the stomach and a portion of the stomach is tied to the lower esophagus in an attempt to tighten the lower esophageal sphincter which prevents acid from moving up into the esophagus.
An article was recently published looking at data over a three-year period following 84 patients who received the TIF procedure. This article looked at overall patient satisfaction, complications, and proton pump inhibitor use. Using a global assessment the patients fell into three categories:
- Cured : defined as no need for medications and symptoms resolved = 56%
- Improved: defined as an 80% decrease in medication use = 22%
- Ongoing GERD: defined as daily acid reflux and need for medications = 22%
Esophageal acid exposure improved in 61% of the patients. Those with mild esophagitis had the best improvement and those with severe esophagitis had modest improvement. Twenty-four percent of the patients continued to have severe esophagitis which was evidenced by an endoscopy procedure. A total of 3 serious complications occurred: 2 perforations and one postoperative bleed.
So where would an alternative therapy such as the TIF procedure fit in the treatment of GERD? The advantages of the TIF procedure are that it is incisionless compared to the standard Nissen, and it may prevent regurgitation which medications don’t. The problem is, the two current methods of treating GERD are very effective and have been around a long time, thus becoming the standards of comparison.
I have seen several billboards and commercials promoting this procedure in the DFW area as a cure for reflux. I would argue, although this new technique is interesting and exciting, it is still being refined and has the potential for serious complications. Although most of the patients did feel better after the procedure, the acid exposure improved in only 61% of the patients, compared to more than 90% with medications.
Eventually the TIF technique may be refined enough to be a real competitor to medications or Nissen. But for now I advise my patients that the data for TIF is not as good as our current standard of care, so keep taking the medicines.
I do have great news for anyone who has reflux!! If you suffer from acid reflux, contact my office because we are enrolling in an exciting new reflux trial for those who continue to have symptoms in-spite of medication usage.
Disclaimer: The information presented on this website is not intended to take the place of your personal physician’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your healthcare provider to determine what is right for you. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical condition