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Saying Goodbye to GERD
If you have symptoms of acid reflux more than twice a week, you may have a condition known as GERD – gastroesophageal reflux disease. If left untreated, reflux can increase the risk of esophageal cancer. In this episode, Dr. Kenneth Tieu discusses what causes reflux disease and what surgical options are available to improve your quality of life.
Featuring:
Kenneth Tieu, M.D
Kenneth Tieu, MD, is Board-certified in General Surgery and is Fellowship-trained in minimally invasive surgery. He attended the University of California, San Diego for his undergraduate studies and Medical School at Pennsylvania State University College of Medicine in Hershey. He completed his Internship and Residency at the University of Texas Health Science Center in Houston as well as a Fellowship in Minimally-Invasive Surgery. He specializes in bariatric and reflux surgery. Transcription:
Maggie McKay (Host): If you've ever had a burning chest pain or a feeling of heartburn, you could have acid reflux. But what if you experience it a few times a week? That could lead to gastroesophageal reflux disease or GERD. What is that? Dr. Kenneth Tieu, board-certified general surgeon and bariatric surgeon at Health First, will tell us how to say goodbye to acid reflux or GERD and what the LINX procedure is and how it can help.
This is Putting Your Health First, the podcast from Health First. My name is Maggie McKay. Dr. Tieu, thank you so much for joining us today. I can't wait to hear more about the LINX procedure. But first, what is acid reflux and GERD?
Dr Kenneth Tieu: Well, acid reflux is a condition in which stomach contents, whether it be acid, bile, pepsin, or anything else in the stomach refluxes back into the esophagus through a leaky valve. At the end of the esophagus, there's something called your lower esophagus sphincter. That sphincter has failed and relaxes too much and stays open and allows those stomach content to reflux back up into the esophagus.
Maggie McKay (Host): And then, what's GERD?
Dr Kenneth Tieu: Well, GER is the condition. GERD, gastroesophageal reflux is the disease. I think what happens is people get these terms all mixed up. You get GERD, you get heartburn. The symptoms are the heartburn, your dysphagia, which is difficulty swallowing, your pain, the sour taste in the back of your throat, those are the symptoms. The actual disease name is GERD, gastroesophageal reflux disease, and what I just explained is the mechanism of that disease.
Maggie McKay (Host): And how common is that? Is it mostly in adults?
Dr Kenneth Tieu: It is more common than most people think. It is fairly common in newborns. Newborns tend to resolve this disease spontaneously as they get older, and their body parts develop. But it is more common than we think in adults. Approximately, 30 million people in this country experience reflux at least a couple times a week. So, it's a very common disease process that we find in the population in this country.
Maggie McKay (Host): And what causes acid reflux?
Dr Kenneth Tieu: Part of it is that no one knows what causes it, but we know the factors that can contribute to this. Part of it is our diet has not been the greatest. So, our overweight and obesity population has increased, so we have increased abdominal pressure from obesity that can cause it. Pregnancy is another factor that would increase someone's risk of having reflux disease. Smoking or being regularly exposed to secondhand smoke that tends to relax that lower esophageal sphincter a little bit more, causing more gastric contents to reflux. And there's a bunch of different medications that may be involved in relaxing that lower esophageal sphincter and causing more reflux. But the bottom line is no one knows why it happens. But there are factors that can contribute to this. And we find that it tends to also run in families, especially with people with hiatal hernias, those also tend to run in families, but no one knows exactly why it starts out and how it is developed.
Maggie McKay (Host): Dr. Tieu,
I understand that Health First performs a procedure called links that not many hospitals do. Can you tell me more about that?
Dr Kenneth Tieu: So, LINX, or another name for LINX is something called magnetic sphincter augmentation. So in terms of surgery for reflux disease, the original surgery is something called a Nissen fundoplication. That's where people would go in. Usually at first, it was done through a big incision through the chest, then people got a little bit better and made an incision in the abdomen. And back in the 1990s, they started doing these surgeries laparoscopically with some tiny, tiny poke holes through the abdomen.
The only problem with Nissen fundoplication was there was a lot of side effects with it. One of the big side effects was the inability to belch or vomit. The durability of the surgery was not great, so we're seeing people eight, 10 years down the road that their fundoplication was starting to fall apart. And the stigma of the surgery itself, you saw a lot of people that couldn't eat. So when I say a lot, that is probably 10%, 15% of these patients didn't get great results, but you had 85% that did real well. But the 10% or 15% of patients that didn't get great results kept coming back. So, you saw a lot of these people that, say, your GI doctor or your family practitioner saw these patients back continuously and they felt that this surgery wasn't great, so you didn't see people getting referred for these surgeries until they were really far advanced in their disease. And what we know about that is once you get too far advanced in your disease and your hiatal hernia gets way larger, the success of these surgeries tend to go down. So, I always tell people to attack these surgeries sooner rather than later.
So, you saw a lot of these side effects. You saw the stigma of the surgery wasn't great. So, a company called Torax came out with this LINX device. They started doing clinical trials back in around 2005, and they finally got FDA approval back in 2011. What it consists of is a little magnetic ring. It's a bracelet made of titanium beads. At the center of each bead is a tiny rare earth magnet.
So, what we do is we go in after we have determined that that patient has a faulty lower esophageal sphincter, and it has significant reflux disease. We would go in laparoscopically. Most patients have some sort of a hiatal hernia that we repair. What that means is where the esophagus comes through, that diaphragm, that opening has enlarged. So we tighten up that hiatus or suture up the hiatus and tighten up that hiatal hernia. And then, we make a little tunnel around the end of the esophagus, and we measure the size of the esophagus, and we put this little magnetic ring around the end of the esophagus. What that magnetic ring does is it uses the magnetic forces and attracts each other and pulls that lower esophageal sphincter closed at rest. So at rest, the sphincter is augmented back to normal pressures, so you don't get reflux. Once you eat, you get esophageal peristalsis that forces that ring open, allows food to go through the esophagus into your stomach. And then once the food passes, the ring shuts back down and prevents stomach contents from coming back up into your esophagus.
Maggie McKay (Host): How new is this LINX procedure?
Dr Kenneth Tieu: The clinical trials for this started back in around 2005 or so, and then it got FDA approved in 2011. And more and more insurances are starting to approve these things, so we're seeing more and more LINX procedures being done. We've done, I want to say, about 600 procedures here at Health First. We actually did the most procedures in the country last calendar year. So, we've got quite a bit of experience doing this procedure.
Maggie McKay (Host): That's impressive. What's the recovery like? Is this less invasive, this type of surgery than what they used to?
Dr Kenneth Tieu: Less invasive in terms of the original procedure, but it's all done laparoscopically, meaning that there are five to six tiny poke holes, measuring approximately half a centimeter each. The procedure lasts less than one hour. We admit patients overnight just for observation. Technically, they could possibly go home, but we'd like to keep an eye on these patients and make sure they're able to eat the next day. Once they're able to eat the next day, they're able to go home on a regular diet as opposed to the older surgeries where they had to be on a liquid diet for quite a bit of time. Patients after a LINX procedure are able to advance to a normal diet almost immediately. And we do want these patients to eat as regular diet as possible, because when we put this device around the end of esophagus, your body's natural tendencies to try to scar around the device. So if you don't eat right away, people tend to get too much scarring and they get a little bit more difficulty swallowing after the procedure. So, it's kind of like, say, you had a knee replacement. What people do is they work out, they do physical therapy after their knee replacement to work out that new knee to get the stiffness out of it.
So when we put this LINX device in, same concept. We want you to work out your esophagus. What that means is we have them eat normal food. In addition, we have them eat a tiny bite every single hour to get that ring opening as much as possible and work out that esophagus so that that stiffness goes away over time.
Maggie McKay (Host): I like that kind of physical therapy, doctor. Does the Linx procedure get rid of it for good, GERD and acid reflux?
Dr Kenneth Tieu: Yes. So, we looked at our data and the data across the country, about 90% of patients who undergo a LINX procedure, their reflux symptoms go away completely and they're off their acid reduction medications. As we know, there are side effects with the acid reduction medications, such as your Prilosec, your omeprazole. So, I would say about 90% of those patients that come to us who are good candidates for the LINX procedure, those patients are off medications without having any of those reflux symptoms.
Maggie McKay (Host): That's amazing. Is there anything else you'd like to add that we didn't cover, Dr. Tieu?
Dr Kenneth Tieu: When we talk about reflux, I think there's a misperception of what reflux is. A lot of people they think about reflux or GERD, they think about heartburn. Heartburn is just one of the symptoms of reflux disease. We find a lot of people that come in for other reasons, like they've seen their ear, nose and throat doctors because they frequent sinusitis, a chronic cough. So, there's a lot of other that people don't realize that are maybe contributed by the reflux disease.
So if there's any questions about some of these symptoms that you may be experiencing, I would talk to your doctor, whether it be your ENT doctor, your family care doctor, or your gastroenterologist about these symptoms and whether they may be related to reflux disease and whether those could be treated, whether it be medically or surgically. So, don't hesitate to seek medical help when you have some of these symptoms that you think may not be related to reflux disease.
Maggie McKay (Host): Good idea. Dr. Tieu, from someone who lives with someone who has acid reflux, thank you so much for explaining what it is and how to get rid of it. This has been so helpful. We appreciate your time.
Dr Kenneth Tieu: No problem. My pleasure.
Maggie McKay (Host): That was Dr. Kenneth Tieu, board-certified general surgeon and bariatric surgeon at Health First. Thanks for listening to Putting Your Health First. For more information, visit hf.org/reflux. If you found this podcast helpful, please share it on your social channels and check out our entire library for topics of interest to you. Thank you again for listening. My name is Maggie McKay. Be well.
Maggie McKay (Host): If you've ever had a burning chest pain or a feeling of heartburn, you could have acid reflux. But what if you experience it a few times a week? That could lead to gastroesophageal reflux disease or GERD. What is that? Dr. Kenneth Tieu, board-certified general surgeon and bariatric surgeon at Health First, will tell us how to say goodbye to acid reflux or GERD and what the LINX procedure is and how it can help.
This is Putting Your Health First, the podcast from Health First. My name is Maggie McKay. Dr. Tieu, thank you so much for joining us today. I can't wait to hear more about the LINX procedure. But first, what is acid reflux and GERD?
Dr Kenneth Tieu: Well, acid reflux is a condition in which stomach contents, whether it be acid, bile, pepsin, or anything else in the stomach refluxes back into the esophagus through a leaky valve. At the end of the esophagus, there's something called your lower esophagus sphincter. That sphincter has failed and relaxes too much and stays open and allows those stomach content to reflux back up into the esophagus.
Maggie McKay (Host): And then, what's GERD?
Dr Kenneth Tieu: Well, GER is the condition. GERD, gastroesophageal reflux is the disease. I think what happens is people get these terms all mixed up. You get GERD, you get heartburn. The symptoms are the heartburn, your dysphagia, which is difficulty swallowing, your pain, the sour taste in the back of your throat, those are the symptoms. The actual disease name is GERD, gastroesophageal reflux disease, and what I just explained is the mechanism of that disease.
Maggie McKay (Host): And how common is that? Is it mostly in adults?
Dr Kenneth Tieu: It is more common than most people think. It is fairly common in newborns. Newborns tend to resolve this disease spontaneously as they get older, and their body parts develop. But it is more common than we think in adults. Approximately, 30 million people in this country experience reflux at least a couple times a week. So, it's a very common disease process that we find in the population in this country.
Maggie McKay (Host): And what causes acid reflux?
Dr Kenneth Tieu: Part of it is that no one knows what causes it, but we know the factors that can contribute to this. Part of it is our diet has not been the greatest. So, our overweight and obesity population has increased, so we have increased abdominal pressure from obesity that can cause it. Pregnancy is another factor that would increase someone's risk of having reflux disease. Smoking or being regularly exposed to secondhand smoke that tends to relax that lower esophageal sphincter a little bit more, causing more gastric contents to reflux. And there's a bunch of different medications that may be involved in relaxing that lower esophageal sphincter and causing more reflux. But the bottom line is no one knows why it happens. But there are factors that can contribute to this. And we find that it tends to also run in families, especially with people with hiatal hernias, those also tend to run in families, but no one knows exactly why it starts out and how it is developed.
Maggie McKay (Host): Dr. Tieu,
I understand that Health First performs a procedure called links that not many hospitals do. Can you tell me more about that?
Dr Kenneth Tieu: So, LINX, or another name for LINX is something called magnetic sphincter augmentation. So in terms of surgery for reflux disease, the original surgery is something called a Nissen fundoplication. That's where people would go in. Usually at first, it was done through a big incision through the chest, then people got a little bit better and made an incision in the abdomen. And back in the 1990s, they started doing these surgeries laparoscopically with some tiny, tiny poke holes through the abdomen.
The only problem with Nissen fundoplication was there was a lot of side effects with it. One of the big side effects was the inability to belch or vomit. The durability of the surgery was not great, so we're seeing people eight, 10 years down the road that their fundoplication was starting to fall apart. And the stigma of the surgery itself, you saw a lot of people that couldn't eat. So when I say a lot, that is probably 10%, 15% of these patients didn't get great results, but you had 85% that did real well. But the 10% or 15% of patients that didn't get great results kept coming back. So, you saw a lot of these people that, say, your GI doctor or your family practitioner saw these patients back continuously and they felt that this surgery wasn't great, so you didn't see people getting referred for these surgeries until they were really far advanced in their disease. And what we know about that is once you get too far advanced in your disease and your hiatal hernia gets way larger, the success of these surgeries tend to go down. So, I always tell people to attack these surgeries sooner rather than later.
So, you saw a lot of these side effects. You saw the stigma of the surgery wasn't great. So, a company called Torax came out with this LINX device. They started doing clinical trials back in around 2005, and they finally got FDA approval back in 2011. What it consists of is a little magnetic ring. It's a bracelet made of titanium beads. At the center of each bead is a tiny rare earth magnet.
So, what we do is we go in after we have determined that that patient has a faulty lower esophageal sphincter, and it has significant reflux disease. We would go in laparoscopically. Most patients have some sort of a hiatal hernia that we repair. What that means is where the esophagus comes through, that diaphragm, that opening has enlarged. So we tighten up that hiatus or suture up the hiatus and tighten up that hiatal hernia. And then, we make a little tunnel around the end of the esophagus, and we measure the size of the esophagus, and we put this little magnetic ring around the end of the esophagus. What that magnetic ring does is it uses the magnetic forces and attracts each other and pulls that lower esophageal sphincter closed at rest. So at rest, the sphincter is augmented back to normal pressures, so you don't get reflux. Once you eat, you get esophageal peristalsis that forces that ring open, allows food to go through the esophagus into your stomach. And then once the food passes, the ring shuts back down and prevents stomach contents from coming back up into your esophagus.
Maggie McKay (Host): How new is this LINX procedure?
Dr Kenneth Tieu: The clinical trials for this started back in around 2005 or so, and then it got FDA approved in 2011. And more and more insurances are starting to approve these things, so we're seeing more and more LINX procedures being done. We've done, I want to say, about 600 procedures here at Health First. We actually did the most procedures in the country last calendar year. So, we've got quite a bit of experience doing this procedure.
Maggie McKay (Host): That's impressive. What's the recovery like? Is this less invasive, this type of surgery than what they used to?
Dr Kenneth Tieu: Less invasive in terms of the original procedure, but it's all done laparoscopically, meaning that there are five to six tiny poke holes, measuring approximately half a centimeter each. The procedure lasts less than one hour. We admit patients overnight just for observation. Technically, they could possibly go home, but we'd like to keep an eye on these patients and make sure they're able to eat the next day. Once they're able to eat the next day, they're able to go home on a regular diet as opposed to the older surgeries where they had to be on a liquid diet for quite a bit of time. Patients after a LINX procedure are able to advance to a normal diet almost immediately. And we do want these patients to eat as regular diet as possible, because when we put this device around the end of esophagus, your body's natural tendencies to try to scar around the device. So if you don't eat right away, people tend to get too much scarring and they get a little bit more difficulty swallowing after the procedure. So, it's kind of like, say, you had a knee replacement. What people do is they work out, they do physical therapy after their knee replacement to work out that new knee to get the stiffness out of it.
So when we put this LINX device in, same concept. We want you to work out your esophagus. What that means is we have them eat normal food. In addition, we have them eat a tiny bite every single hour to get that ring opening as much as possible and work out that esophagus so that that stiffness goes away over time.
Maggie McKay (Host): I like that kind of physical therapy, doctor. Does the Linx procedure get rid of it for good, GERD and acid reflux?
Dr Kenneth Tieu: Yes. So, we looked at our data and the data across the country, about 90% of patients who undergo a LINX procedure, their reflux symptoms go away completely and they're off their acid reduction medications. As we know, there are side effects with the acid reduction medications, such as your Prilosec, your omeprazole. So, I would say about 90% of those patients that come to us who are good candidates for the LINX procedure, those patients are off medications without having any of those reflux symptoms.
Maggie McKay (Host): That's amazing. Is there anything else you'd like to add that we didn't cover, Dr. Tieu?
Dr Kenneth Tieu: When we talk about reflux, I think there's a misperception of what reflux is. A lot of people they think about reflux or GERD, they think about heartburn. Heartburn is just one of the symptoms of reflux disease. We find a lot of people that come in for other reasons, like they've seen their ear, nose and throat doctors because they frequent sinusitis, a chronic cough. So, there's a lot of other that people don't realize that are maybe contributed by the reflux disease.
So if there's any questions about some of these symptoms that you may be experiencing, I would talk to your doctor, whether it be your ENT doctor, your family care doctor, or your gastroenterologist about these symptoms and whether they may be related to reflux disease and whether those could be treated, whether it be medically or surgically. So, don't hesitate to seek medical help when you have some of these symptoms that you think may not be related to reflux disease.
Maggie McKay (Host): Good idea. Dr. Tieu, from someone who lives with someone who has acid reflux, thank you so much for explaining what it is and how to get rid of it. This has been so helpful. We appreciate your time.
Dr Kenneth Tieu: No problem. My pleasure.
Maggie McKay (Host): That was Dr. Kenneth Tieu, board-certified general surgeon and bariatric surgeon at Health First. Thanks for listening to Putting Your Health First. For more information, visit hf.org/reflux. If you found this podcast helpful, please share it on your social channels and check out our entire library for topics of interest to you. Thank you again for listening. My name is Maggie McKay. Be well.