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    Injection Helps GERD Patients

    Surgical treatments for patients with gastroesophageal reflux disease (GERD) are designed to prevent stomach contents from backing up into the esophagus. Most of the approaches have required invasive surgery such as procedures to wrap the stomach around the lower end of the esophagus. One less invasive method that scientists have looked at in the past involves injecting a substance into the lower esophageal sphincter to reinforce it.

    The esophageal sphincter is like a gate that leads from the esophagus into the stomach -- it opens into the stomach to let food in, but in patients with GERD it also allows stomach contents to go back up into the esophagus, causing discomfort and irritating the esophagus.

    Researchers gathered at the Digestive Disease Week 2000 in San Diego to discuss new ways of treating GERD in patients that don't get better with medication and lifestyle changes. Jacques Deviere, MD, from Erasme Hospital in Brussels, Belgium presented research on a technique that injects a substance similar to that found in soft contact lenses, into the lower esophageal sphincter to strengthen it.

    He explained that the relaxation of this sphincter plays a key role in the development of GERD and for this reason, scientists have explored ways of making it stronger. "The idea of reinforcing the lower esophageal sphincter…by injecting something has already been developed years ago," said Dr. Deviere.

    In the past, researchers have used other materials but none have been satisfactory. Scientists tried to use Teflon for this purpose but found that it was too thick to easily inject into the sphincter, which is very thin. Collagen was also tried, but that didn't work long-term because in time collagen is absorbed by the body.

    This new, spongy material appears to be better suited for the job, and has already been used in other procedures. Dr. Deviere and his colleagues conducted a small pilot study of this procedure and they've been pleased with the results. In all but one patient, the procedure was successful at increasing the pressure of the lower esophageal sphincter significantly. No patients in the study suffered from complications from the procedure.

    One of the advantages of the procedure is that it can be done as an out-patient in about 15 minutes. In addition, patients are sedated but don't have to undergo general anesthesia.


    Editorial Commentary by Dr. Malcolm Robinson: Effective surgical treatment of gastroesophageal reflux disease, often called GERD, is something of a "Holy Grail" in gastroenterology. There has been a strong desire to have an alternative to lifetime use of medicine for patients with frequent heartburn. Surgery has had many disadvantages including pain, risk of complications, and even occasional death. Medical treatments have been viewed as expensive and something of a nuisance. Therefore, the availability of a simple injection in the lower end of the esophagus to 'fix' acid reflux would be most welcome. However, most of us who focus on diseases of the esophagus are still very dubious about such approaches. We have only to look at the terrible continued controversies regarding breast implants to get some inkling of the complex risks involved in introducing foreign substances into the body. There are absolutely no long-term data on the technique described by Dr. Deviere and his colleagues. Therefore, his procedure, and all like it, must remain entirely experimental until sufficient information is available to warrant more general application. Medications are excellent for the treatment of heartburn, and they appear to be quite safe for short and long-term use. They remain the current 'gold standard.'



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