New Clinical Trial for Severe GERD

posted June 2017

Living with
CHRONIC REFLUX?

See if the LESS GERD Trial is right for you, Click on the link below.

Gastroesophageal reflux disease (GERD) is a chronic condition that causes uncomfortable heartburn and regurgitation for millions of Americans. Most people with GERD receive relief through daily acid blocking medications called proton pump inhibitors (PPI). However, nearly 30% of PPI users continue to struggle with such burdensome symptoms as regurgitation and nighttime reflux.

If you struggle with GERD and are not getting complete relief from your daily heartburn medications, you may be a candidate for the LESS GERD Clinical Trial. The trial is for EndoStim – an investigational, minimally-invasive procedure that may help improve GERD symptoms.

What is EndoStim?

EndoStim is a new, minimally-invasive approach to GERD treatment, designed to restore normal function to the lower esophageal sphincter (LES).

The EndoStim system uses a technology called neurostimulation in which two small electrodes connected to a “lead” are placed on the LES. The lead is connected to a small device called a neurostimulator. The neurostimulator and lead deliver mild electrical signals to the LES automatically throughout the day (not normally felt or sensed by the patient). This gentle stimulation is designed to restore normal function to the LES.

The EndoStim system is placed through a minimally-invasive procedure. The device is implanted below the skin. And unlike traditional anti-reflux surgery, the EndoStim procedure is designed to preserve the body’s natural anatomy in order to reduce or avoid gastro-intestinal side effects. 

The EndoStim system is currently being offered at select centers through the LESS GERD Clinical Trial.

http://www.lessgerd.com/

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New Esophageal Atresia Clinic in New York 

Second behind Boston USA

June 2017

Esophageal atresia (EA) is a congenital condition (present at birth) in which the esophagus is interrupted and fails to connect the mouth to the stomach as it should. The upper part of the esophagus ends in a blind pouch, and, in the most common form, the lower esophagus connects the airway (trachea) to the stomach (a trachehoesophageal fistula, or TEF). These conditions (EA and TEF) can occur separately, but most often occur together. Babies with EA, TEF, or EA-TEF must undergo surgical repair, often very soon after birth. Without treatment, attempting to eat could cause babies to aspirate milk and stomach acid into the trachea and lungs.

http://columbiasurgery.org/news/2014/04/01/nypcolumbia-establishes-esophageal-atresia-clinic

Esophageal Disorders Program
at NewYork-Presbyterian/Columbia University Medical Center

630 West 168th Street
New York, NY 10032
877.586.4212

ESOPHAGEAL DISORDERS PROGRAM

The two most common types of esophageal cancer are squamous cell carcinoma, most often occurring in the upper and middle portions of the esophagus, and adenocarcinoma, affecting the mucous-secreting cells in the lower portion near the stomach. Other rare forms of the disease include sarcoma, lymphoma, small cell carcinoma and spindle cell carcinoma. In addition, breast and lung cancers can metastasize (spread) to the esophagus. Achalasia is a rare disorder of the smooth muscle layer of the esophagus in which muscular ability to move food down the esophagus (peristalsis) is impaired, and the entry to the stomach or the lower esophageal sphincter (LES) fails to relax properly in response to swallowing. Barrett’s esophagus is a condition in which repeated contact with gastric acid (gastroesophageal reflux, or GERD) transforms a patient’s esophageal cells from normal squamous epithelium to abnormal intestinalized columnar epithelium. Esophageal atresia (EA) is a rare congenital condition (present at birth) in which the esophagus fails to connect to the stomach as it should and ends in a blind pouch instead. Gastroesophageal reflux disease (GERD), also called acid reflux, is a common digestive disorder in which stomach contents regurgitate (reflux) into the esophagus. Also called heartburn, GERD often causes inflammation and damage to the esophagus and occasionally to the lungs and vocal cords. Prolonged untreated GERD can lead to Barrett’s esophagus, a dangerous precancerous condition. Hiatal Hernia In a hiatal hernia (also called hiatus or diaphragmatic hernia), a portion of the stomach penetrates (herniates) through a weakness or tear in the hiatus of the diaphragm, the small opening that allows the esophagus to pass from the neck and chest to its connection with the stomach. Difficulty swallowing, also called dysphagia, may indicate a problem in the throat or esophagus. There are many causes of dysphagia, including the following:

http://columbiasurgery.org/conditions-and-treatments/esophageal-atresia

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New Idea in the USA for treating Gastroparesis

2017

New Program Offers Multidisciplinary Treatment and Hope to Patients with Gastroparesis.

The innovative POP procedure helps alleviate symptoms without surgery.

For patients with gastroparesis, long-term relief from nausea, vomiting and bloating may have seemed like an impossible dream. However, medical experts have discovered the secret to conquering this chronic condition. Effective patient care for gastroparesis requires innovative treatment combined with the expertise of physicians from multiple disciplines.

Challenges of traditional treatment

The most common treatments for gastroparesis include pain management, medication and surgery. However, using just one of these treatments is unlikely to relieve the patient’s symptoms. Physicians must consider the patient’s overall health, including diet, psychology and pain levels. When patients receive treatments from physicians in multiple disciplines, the overall treatment plan usually lacks cohesion and focus.

Because gastroparesis is such a rare disorder, few medical centres have had enough exposure to patients with this condition to develop effective treatment plans. Plus, the therapies are evolving so rapidly that many hospitals are struggling to keep up with the changes.

Click here to read full report

New Program Offers Multidisciplinary Treatment and Hope to Patients with Gastroparesis

https://my.clevelandclinic.org/about?_ga=2.86775832.185553693.1495666822-1516827183.1495664859

Breaking news for dysphagia

Breaking news – A potential game changer for patients with profound oropharyngeal dysphagia

GO READ

http://www.birth-defect.org/other-info/#breaking-news-for-dysphagia

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Swallow: A Documentary Dysphagia

Please watch to understand

https://www.youtube.com/watch?v=MrbEUDO6S5U?rel=0

Read More

http://swallowingdisorderfoundation.com/

Published on 13 Aug 2014

Speech pathologist Tiffany Turner explains how swallowing works, what causes dysphagia, and how dysphagia can be treated. For more information and free resources

https://www.youtube.com/watch?v=1pNOnTCtRxM?rel+0

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SWALLOWING VIDEO shows how they look into this

Published on 15 Jan 2014

This video gives an overview of how swallowing works, how it can sometimes go wrong, and possible ways to treat those problems.

https://www.youtube.com/watch?v=_dBPKBg8jXM?rel=0

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 Reflux Infants Support

 If you have any questions, or would like further information, please contact the Reflux Infants Support Association at 

http://www.healthdirect.gov.au/partners/reflux-infants-support-association#!

http://www.reflux.org.au/

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New  idea to treat GORD

19th July 2016

Now acid reflux can be banished for good without surgery: New technique using electric needle toughens up your insides

Many people suffer from occasional acid reflux, but for some it becomes a chronic problem that can lead to ulcers and potentially cancer. Matthew Foster, 28, a Royal Engineer who lives near Ripon, North Yorkshire, underwent a new NHS procedure, as he tells CAROL DAVIS.

THE PATIENT 

All my life I’ve kept pretty fit, eaten healthily and had no health worries. But around five years ago I started having a painful burning feeling in my throat after I’d been hurtling around the rugby field, or if I’d been for a jog. I knew it was heartburn, though didn’t think much could be done so I just bought over-the-counter remedies — Gaviscon liquid helped, and so did Rennie tablets, which I’d take after food or exercise. But I was gradually having to take more and more — in just one day I’d get through a packet of Rennies and a whole bottle of Gaviscon.

Matthew suffered from chronic heartburn, presumably due to a small hernia, and underwent the new procedure

Matthew suffered from chronic heartburn, presumably due to a small hernia, and underwent the new procedure If I went for a pint with my mates I’d have to take a sip of Gaviscon before going out, and then again as soon as I got back to stop the painful burning. Two years ago — around three years after the problem first started — I went to my GP, who confirmed that it was acid reflux causing my symptoms. He explained that acidic juices from my stomach were rising up into my throat because the valve separating the gullet and stomach was too weak to keep them down.

He suspected that this had been partly caused by a small hiatus hernia he said I had — basically part of my stomach was being squeezed, pushing the stomach contents up the gullet. I was prescribed lansoprazole, which reduces the amount of acid your stomach produces and referred to the James Cook University Hospital in Middlesbrough for more tests.

Two months later I had an endoscopy — where they put a flexible tube with a camera on the end down your throat — and a special X-ray called a barium swallow to see where the stomach acid was in my gullet. These confirmed I had a hiatus hernia and acid reflux which needed treatment with surgery. The doctors told me they could operate to wrap part of my stomach around the bottom of the gullet — this would strengthen the valve and stop acid washing back up. But that sounded like a major operation, and I really didn’t want that. So I went on taking the lansoprazole daily. 

I even tried avoiding things that made it worse, such as pastry and lager. It wasn’t enough though, and the heartburn got unbearable. After training, I’d be sick as acid washed back up my throat — exercise clearly put extra strain on my stomach. I also didn’t like the idea of being on pills for life, so I got referred back to the James Cook. 

This time I saw Dr Y.K.S. Viswanath, who said they was a new procedure to end acid reflux without surgery. It involves putting a tube with electrodes at the end down my throat and onto the faulty valve. The electrodes fire radiofrequency waves at the valve to strengthen it and help it close properly. I had the hour-long procedure in April this year, under local anaesthetic. I could feel the tube going down my throat, and it hurt each time a blast of radiofrequency burnt the tissue.

I went home that afternoon, with instructions to keep to a liquid diet for two weeks while my throat healed. I took co-codamol for a few days, then I was fine. Now I can eat and drink what I want, and I don’t need to take anything. It’s a miracle operation — there is no more heartburn, even when I train hard or go out for a pint, which is wonderful.

THE SURGEON

Y.K.S. Viswanath is a consultant upper gastrointestinal and laparoscopic surgeon at the James Cook University Hospital.

Acid reflux or gastro-oesophageal reflux disease (GORD) is very common, affecting one in three of us. It occurs when the sphincter, a valve between the stomach and gullet, doesn’t work properly, allowing stomach acid to wash back up the gullet and causing heartburn. Normally the valve opens to allow fluid and food to pass into the stomach and closes to prevent these flowing back up the oesophagus. In GORD, the muscles in the valve are weakened, often as a result of lifestyle factors such as obesity, smoking or diet — spicy food and caffeine can irritate it — so it doesn’t close as it should. Some patients have acid reflux that’s made worse by a hiatus hernia — where part of the stomach protrudes above the diaphragm into the chest, squeezing the stomach contents back up.

Acid reflux occurs when the sphincter, a valve between the stomach and gullet, doesn¿t work properly, allowing stomach acid to wash back up the gullet and causing heartburn

Acid reflux occurs when the sphincter, a valve between the stomach and gullet, doesn’t work properly, allowing stomach acid to wash back up the gullet and causing heartburn.
 This is problematic as chronic acid reflux can lead to ulcers, bleeding and the pre-cancerous condition Barrett’s oesophagus. Lifestyle changes, for instance, avoiding caffeine and citrus fruit (which can increase the amount of stomach acid) can help.

Antacids such as Gaviscon, which coats the stomach lining to stop acid rising, are also worth trying, or doctors can prescribe drugs to reduce stomach acid, which patients usually have to take for life. When these fail, we can offer surgery. Conventionally this means a keyhole procedure to wrap part of the stomach around the gullet, which strengthens the valve. But not all patients are suitable for or want surgery, so a newer option, called Stretta, is better. It has been approved for use in the NHS and is now available at two NHS trusts (at South Tees Hospitals NHS Foundation Trust and the Royal Liverpool And Broadgreen University Hospitals NHS Trust) as well as privately.

It involves passing a catheter, a tube which is roughly 16-18 mm in diameter, down the throat. At the end of the catheter are tiny prongs that fire radiofrequency waves — a low voltage electrical current — at the valve.

The procedure involves passing a catheter, a tube which is roughly 16-18 mm in diameter, down the throat. At the end of the catheter are tiny prongs that fire a low voltage electrical current at the valve
The procedure involves passing a catheter, a tube which is roughly 16-18 mm in diameter, down the throat. At the end of the catheter are tiny prongs that fire a low voltage electrical current at the valve
This damages the tissue and causes tiny scars — as these heal, new tissue forms and the valve becomes bulkier and stronger. The procedure takes up to 60 minutes, usually with the patient under sedation. First, we spray local anaesthetic down the throat. Then we pass a camera down so we can identify exactly where the valve is.

We pass a guide wire down to the sphincter, and over that, we feed the Stretta catheter until the prongs are in the right place. We fire for two one-minute spells on one side, and then move it down and give more cycles — 14 in all. Then we withdraw the catheter. We give the patient a drink straight after to check the swallowing reflex works and that we haven’t damaged any tissue. The patient goes home that afternoon. They need to stick to a liquid diet for two weeks to allow the area to heal. They can also take Calpol liquid if they need painkillers.

Thanks to NICE approving Stretta for use three years ago, it is available on the NHS and will be adopted by more NHS trusts. Although it is not suitable for everyone, it is a solution to heartburn without the need for surgery or patients being on long-term medication.

The procedure costs around £5,000-£5,500 privately, or £3,000 to the NHS. UK (England)

WHAT ARE THE RISKS?

There is a small risk of bleeding and perforation of the gullet, although this is the same with any endoscopic procedure. There may be some pain during the procedure. Painful swallowing and sore throat for a few weeks.

‘This is a low-risk procedure and is very effective,’ says Chris Sutton, a consultant general and upper gastrointestinal surgeon at the University Hospitals of Leicester NHS Trust. It could be offered to many more patients, but since the catheter costs £2,500-3,000 and is single-use, so goes in the bin afterwards, it is more expensive than medication.

‘It even costs more than some types of keyhole surgery, which I suspect is why it’s not more widely available.

http://www.dailymail.co.uk/health/article-3696002/Me-operation-acid-reflux.html#ixzz4EzBGTIxQ

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