Simple Procedure to Remedy Acid Reflux Disease

Acid reflux disease affects roughly 20% of the US population and causes extreme heartburn and regurgitation, and other complications with the esophagus and other parts of the body.

While medication can temporarily deal with symptoms and pain, the TIF procedure is a revolutionary way to deal with the root cause of the issue.

Due to the unique approach of the TIF procedure, patients typically experience less discomfort, faster recovery and fewer adverse effects.

Most patients are able to return to work and normal activities within a few days after their TIF procedure.

The TIF procedure, using the EsophyX device, reconstructs the antireflux valve at the entrance from the esophagus into the stomach.

This valve opens and closes as food is swallowed and is a physical barrier to reflux.

By preventing reflux, TIF eliminates both the acidic symptoms of reflux such as heartburn and sore throat as well as the non-acid symptoms such as asthma, chronic cough and regurgitation.

Dr. Medhat Fanous is here today to further explain the TIF procedure.
Simple Procedure to Remedy Acid Reflux Disease
Featured Speaker:
Medhat Fanous, MD
Dr. Fanous is a General Surgeon at Aspirus Iron River Hospital and also specializes in Wound Care.
He is the only physician in the entire Upper Peninsula and the entire Aspirus system that performs the TIF procedure on patients with chronic acid reflux disease. TIF does not require any incisions and is performed through the patient’s mouth. TIF’s incisionless approach means less discomfort, faster recovery and no abdominal scars.

Learn more about Dr. Fanous

Melanie Cole (Host):  Acid reflux disease affects roughly around 20% of the U.S. population and can cause extreme heartburn. While medications can temporarily deal with symptoms and pain, there is a procedure that is a revolutionary way to deal with the root cause of the issue. My guest today is Dr. Medhat Fanous. He is a general surgeon at Aspirus Iron River Hospital and also specializes in wound care. Welcome to the show, Dr. Fanous. First, tell us a little about acid reflux or GERD as people know it and they hear about it and what is the first line of defense if someone comes to you and they’ve got acid reflux?  

Dr. Medhat Fanous (Guest):  Hi, Melanie. GERD stands for gastroesophageal reflux disease. It occurs when the stomach acid is not contained within the stomach. The acid goes to the esophagus and to the airway and it burns the lining of these structures. The main reason for that is incompetence of the valve between the stomach and the esophagus which is the muscular tube connecting the mouth to the esophagus. The first line of defense is to try acid reduction medication which is called “proton pump inhibitors” such as Protonix, Prilosec, or Nexium. Most patients will improve on that. Then, the current standard of care is to put them for life on this medication. If the patient has a partial response, we double the dose and then classic referral is when the patient does not respond to any of the above interventions that they were sent to us for consideration of surgery.

Melanie:  Tell us about this revolutionary way to deal with GERD and acid reflux after medication if it doesn’t work anymore and they’re still experiencing these symptoms, they’re worried about Barrett’s Esophagus. What is it you do for them, Dr. Fanous, that is so different than many places around the country?

Dr. Fanous:  I guess there are four problems with starting medication or people taking this medication for life. First, we are treating the symptoms but not the disease itself--not the problem that the valve is incompetent. Second, the stomach is meant to be an acidic environment, so this medication makes it less acidic and this comes with a price because it causes problems with nutrition, absorption and bacterial growth. Also, now we know that these medications cause long-term problems such as osteoporosis, pneumonia, colitis, Vitamin B12 deficiency. Last but not least, even when patients take these medications, they are still deprived from a wide variety of food which affects their quality of life. So, we are offering a different alternative to patients. Up to nine years ago, patients were given a choice either to take the medication or to undergo a big surgery.  Right now, we are offering a surgery which will be done through the mouth where we wrap the stomach around the esophagus. The surgery is without incision and it takes an hour and the patient usually goes home the following day.

Melanie:  Wow. So, this incision-less surgery how does it work and what can people expect if they go in to have this?   

Dr. Fanous:  It works by dealing with the cause of the problem. As I mentioned, the cause is that the valve between the esophagus and stomach is incompetent. When we wrap the stomach around the lower part of the esophagus, we are creating or constructing a valve again. The acid remains in the stomach. Before we offer this surgery to any patient, they undergo an extensive work up. They fill out a questionnaire to tell us the severity of the symptoms, what they tried, for how long they have been on mediation. Then, we ask them to get a special X-ray where we look at the esophagus and see if there is any structure abnormality. We also perform endoscopy where we look inside the stomach to make sure there is no hiatal hernia which appears when there is part of the stomach pulled in the chest, not inside of the abdomen and to see whether the patient is a candidate for this procedure or not. We also, at the same time, place a capsule which measures the acidity at the lower part of the esophagus. Again, this area should not have the same acidity like the stomach because it is not used in this environment.   

Melanie:  How long does this procedure work for? Is it a permanent solution? Might it have to be redone later in life?

Dr. Fanous:  This procedure started about nine years ago. So far, the data is so promising that it comes across as a durable procedure. The success rate that we quote to our patients is, on the literature, about 80%. It means that 80% of the people will be off PPI’s.  If a patient requires another procedure, we can repeat this procedure or we can proceed to the bigger surgery which is called Laparoscopic Nissen Fundoplication. Basically, this procedure does not burn any bridges. It keeps the patients’ options open.

Melanie:  Do you still recommend lifestyle behavioral changes after this procedure? Are there things you would like listeners to know and to do after the procedure to follow so that maybe they don’t suffer from some of those same symptoms?   

Dr. Fanous:  The make or break of the surgery is a strict diet for six weeks until the healing of the valve is established.  As the patient follows the diet, at the end of six weeks they lose a significant amount of weight and, at this point, the patient has two choices. Most of my patients would keep the weight that they lost. Others, now that they can eat the food that they could not eat in the past, unfortunately, go in the other direction and gain more weight.

Melanie:  So then, you want them to do that for quite a while and adhere to a good strict diet and then afterwards, you want them not to gain weight because obesity can contribute. What about other things? You mention that that acid is good for them. That is really what helps with the bacteria and to help in digestion. What do you think of some of the things people try to keep that like apple cider vinegar? Things along those lines.

Dr. Fanous:  Acidy fruit that the patient could not take in the past, now they can. The good thing about our body is the stomach regulates its environment. The patient will have the option of changing his lifestyle or getting nutritional supplement--all of these options which were not present before. My patients usually see the dietician for six weeks after the surgery. During this time, they establish so many good habits that it is really encouraging and we recommend that they continue with the good habits for life. But, again, that is their choice and not everybody follows our recommendation.

Melanie:  In just the last few minutes, Dr. Fanous, give your best advice for those suffering with GERD, what you would like them to know and why they should come to Aspirus for their care.

Dr. Fanous:  I think this procedure provides a very unique option where people can get the procedure done. They go home the following day. They can return to work in a few days and their quality of life is really, really changed. So, I recommend that they read about it. There is so much information on our website and online. We hold free monthly seminars for this purpose. We encourage them to come to our place and ask all the questions. We will evaluate them and if they are a candidate, we will be gladly offering this surgery.

Melanie:  Thank you so much. It’s great information and really a fascinating procedure. You’re listening to Aspirus HealthTalk. For more information you can go to That’s This is Melanie Cole. Thanks so much for listening.