Longmeadow resident and Vietnam veteran Frank Kilcoyne recently underwent a new surgery at Baystate Medical Center – the LINX Reflux Management System – to address his life-long condition of acid reflux or heartburn. ( Frank Kilcoyne has much to smile about these days when he talks about his favorite spices and foods over coffee in his kitchen. His grandmother taught him to cook as a teen, something that helped the retired occupational therapist land a job as a high school student in a hospital cafeteria. However, it is only recently that the 69-year-old Longmeadow resident and Vietnam veteran has been able to enjoy what he makes.
"Life changing for sure," said Kilcoyne who 12 months ago successfully underwent one of the newest surgical treatments for gastroesophageal reflux disease and has become an advocate for what is known as the LINX procedure .
GERD is the result of gastric acid from the stomach escaping into the esophagus due to the weakening of the muscle between the esophagus and the stomach known as the lower esophageal sphincter.
Its symptoms include regurgitation and difficulty swallowing but the most common symptom is heartburn – often a burning sensation behind the breastbone after eating – which is also referred to as acid reflux or acid indigestion.
Baystate’s Dr. John R. Romanelli , who did the hospital’s first LINX implant on Kilcoyne, says more than "one percent of the population has daily heartburn," which he says translates to "millions of people."
"If there is one message to impart is that having heartburn every day is a disease," said Romanelli, noting treatment options include medications as well as surgical procedures.
"It is not normal. It is not what you are eating. It is abnormal. You are not supposed to have heartburn every day. Please go see your doctor if you do."
The LINX management system for reflux involves the insertion into the weaken lower esophageal sphincter of a ring-size band of magnets through minimally-invasive laparoscopic surgery.
Food is still able to enter the stomach as result of swallowing, but the attraction of the titanium-encased magnetic beads to each other on the flexible titanium wire tightens the lower esophageal sphincter to stop the backward flow of stomach acid into the body’s food pipe.
"The minimally invasive procedures allows food to go into the stomach but when closed the beads create a magnetic field that is stronger than the pressure that would push acid into the esophagus," Romanelli said.
"This magnetic field adds to sphincter strength and is called magnetic sphincter augmentation. The device is called LINX."
The technology to address the physical problem of a weaken lower esophageal sphincter through magnetic sphincter augmentation was developed by Minnesota-based Torax Medical and approved by the Food and Drug Administration in 2012 for the treatment of GERD resistant to medical therapy.
The FDA required follow-up studies "to evaluate safety and efficacy of the device," and insurers are starting to cover the procedures, Romanelli said, as "good data coming out shows it is safe and reliable ."
Romanelli said the LINX implant is for a select group of patients whose gastroesophageal reflux is primarily the result of a "weak sphincter."
"The traditional operation is to actually use the fundus of the stomach – which is sort of the very top of the stomach – and wrap that around the bottom of the esophagus to serve as like an extra valve, if you will, to strengthen that sphincter," Romanelli said.
"That operation works very well and we have been doing it since the boom of the laparoscopic era which is about 1991. It is the gold standard for anti-reflux surgery."
Romanelli added this "operation is very effective for people who have what is called a hiatal hernia which is where the natural opening – or hiatus – of the diaphragm allows the esophagus to pass into the abdominal cavity and join the stomach and allows the aorta to pass from the chest cavity into the abdominal cavity to supply blood to the organs below the diaphragm."
"The hiatal hernia gets bigger and when it gets bigger the stomach can then migrate upwards into the chest and that causes reflux mostly due to the physiology of how we breathe," Romanelli said.
"But not everyone has a hiatal hernia. Some people just have a weak sphincter."
He said for these patients the LINX procedure provides "something less than wrapping the stomach around the esophagus."
Romanelli said the fact that Kilcoyne "did not have much of a hiatal hernia" made him a good candidate for the LINX procedure and that Kilcoyne understood the less need for "all the stomach surgery if the esophagus is the problem."
"Frank was my first one. I did him a year ago," said Romanelli who was scheduled to do his fifth LINX procedure this month.
Romanelli said eight-year data from patient studies implies the LINX device "can stay in for decades," something he called "encouraging" in terms of surgical options for patients whose GERD is not being managed by acid-suppressing medications.
He added, "The long-term results of having decades – not months or years – of acid reflux is that it can develop cancer of the esophagus."
"Reflux is the step before the step before the step before cancer," Romanelli said.
"So not to be overly alarmist but the rate at which cancer, specifically adenocarcinoma of the esophagus, is rising, if it were an infectious disease this would be an epidemic."
Medications, both over-the-counter and prescribed, used to treat acid reflux include H2 blockers as well as proton pump inhibitors.
Romanelli said he sees a number of patients "who don’t want to be on proton pump inhibitors anymore" over possible risk factors for certain conditions raised by recent studies he calls "correlative and not causative."
"I see a lot of people who want to get treated because they want to get off their medication," Romanelli said.
"I don’t think that is a poor rationale and the reality is that less than one percent of people eligible for surgery for acid reflux ever seek it. We are woefully under treating the population. But does it mean I should be doing 500 surgeries for this a year? No. I still think you need to be looked at carefully from a physiological standpoint to see if it is appropriate to do these operations."
He added, "With a normal esophagus, if the medicine treats your symptoms well, you are treated."
Romanelli said that "nobody really knows what the inciting factor for acid reflux is."
"Our stomach makes a liter of fluid a day and is supposed to do that," Romanelli said.
"The question is why in some people does it overwhelm the lower esophageal sphincter and go up instead of down."
He added contributing factors can be weight, diet and certain lifestyle behaviors.
"Being overweight puts you at high risk for that. So, some of this is that we are getting increasingly overweight as a society and that is building our population of reflux people. But it is not purely weight-related. I see very thin people with terrible acid reflux so there is an association with the slender build," Romanelli said.
"The way we eat doesn’t help. We shouldn’t be eating within two hours of our bed time. This is quite simple but many people do because of the busy lives that we lead these days. Many people have 12-hour jobs where they don’t have a choice. Many people work second and third shifts where their eating cycle is completely non-physiologically appropriate but by lifestyle they have no choice. These people are all at higher risk for acid reflux."
He added, "What we eat does not help.""Many things relax the lower esophageal sphincter – cigarette smoking, alcohol, tasty things around the holiday time, like chocolate and peppermint, are two of the strongest relaxers of the lower esophageal sphincter," Romanelli said."Fatty foods, spicy foods, especially citrus-based foods like orange juice, pineapple juice, apple juice, grapefruit juice, tomato juice, tomato sauce for pasta, are all very strong relaxers of the lower esophageal sphincter."Romanelli said his advice is to "eat smaller, more frequent meals if needed.""I know a lot of people who eat a small breakfast, a little bit of lunch and a massive dinner and they have heartburn problems," he said."Food is meant to be savored. We should chew thoroughly, we should eat slowly. You definitely give yourself more time to digest when you do that and the stomach will empty faster. The stomach not emptying leads to more reflux. Drinking plenty of fluids while you eat is helpful as well."He added, "If you have daily heartburn you need to see a physician."That is not normal," Romanelli said."It does not mean you need surgery but it does mean you need to be worked up."As someone who has had "digestive problems since I was a kid," Kilcoyne is grateful to have undergone the LINX implant surgery."I have always had heartburn issues," Kilcoyne said."I think I was in my early 20s when I had a glass of wine after a mid-size meal and I thought I was having a heart attack. I went to the hospital with such chest pain. They said they thought I […]
Click here to view original web page at Long-time heartburn patient finds newer surgery ‘life-changing’