Two nonsurgical procedures relieve many symptoms of acid reflux disease including heartburn in people who are not helped by the medications typically used to treat it, U.S. researchers said on Friday.
In this chronic condition, also called gastroesophageal reflux disease, or GERD, stomach acid backs up into the esophagus, irritating its lining and causing inflammation. Persistent, often-severe heartburn is the most common symptom.
Most people are helped if they take a class of drugs called proton pump inhibitors such as AstraZeneca Plc's Nexium and Prilosec, Wyeth's Protonix, Takeda Pharmaceutical Co's Prevacid and Eisai Inc's Aciphex.
For those who are not helped by medications, there are few options short of surgery.
The new study, published in the journal Archives of Surgery, found two rarely performed so-called endoluminal therapies reduced heartburn, swallowing difficulties and voice hoarseness in many patients who underwent them.
Both are done using an endoscope, a long flexible instrument inserted through the mouth and down the esophagus.
One procedure called full-thickness plication uses the endoscope to tighten the junction between the esophagus and the stomach with sutures. The other, called radiofrequency therapy, uses heat to improve the function of the valve between the esophagus and stomach.
In this study, 68 patients underwent radiofrequency treatment and 58 had full-thickness plication.
"I think medication is still the first thing that people should try for reflux," Dr. Louis Jeansonne IV of Ochsner Medical Center, Baton Rouge, Louisiana, one of the researchers, said in a telephone interview.
"Surgery is still the most effective treatment in people who don't have relief with medications. But this study shows that this therapy without surgery is a viable option in patients who either can't have surgery or don't want surgery," Jeansonne added.
Surgery used to treat acid reflux is called laparoscopic fundoplication, in which doctors take the top of the stomach and wrap it around the lower part of the esophagus to create a barrier for acid reflux.
Acid reflux returns more than 80 percent of the time when people stop taking the medications.
"It's nice to be able to offer something less invasive," said Dr. Edward Lin of Emory University School of Medicine in Atlanta, another of the researchers.
Lin noted the two nonsurgical treatments are uncommon in part because health insurance companies typically do not pay for them. Lin added that these nonsurgical treatments do not preclude a patient from getting surgery later if they do not provide relief.