Transcription:
Emerging Technology in the Treatment of Extreme GERD

Deborah Howell (Host): Hello, and welcome to the show. You're listening to Weekly Dose of Wellness. It's brought to you by MemorialCare Healthystem. I'm Deborah Howell, and today's guest is Dr. Atif Iqbal, Medical Director of the MemorialCare Digestive Care Center at Orange Coast Memorial Medical Center. He specializes in minimally invasive bariatric procedures and digestive disorder surgery. Welcome, Dr. Iqbal.

Dr. Atif Iqbal (Guest): Thank you so much for having me.

Deborah: Our pleasure. Today we're going to be talking about emerging technologies in the treatment of extreme GERD. We hear a lot about it, but what exactly is GERD, doctor?

Dr. Iqbal: GERD or gastroesophageal reflux disease is the most common gastrointestinal disorder in the United States. It's affecting about 25 million people in this country. Typically, these patients present with complaint of heart burn, pain behind the sternum, feeling of food getting stuck or coming back, acid taste in their mouth, or sometimes, the complaint of cough late night that also is related to GERD.

Deborah: Okay. How does one develop GERD?

Dr. Iqbal: The GERD typically is merely caused by a malfunctioning of a ring-shaped muscle, which is present in the bottom of the food pipe, what we call the esophagus. Normally, the function of this muscle is to prevent all the acid which we produce in the stomach going upwards, and it prevents the flow of the acid upwards. When it is not functioning, all the exposure of that acid causes the symptoms I just mentioned. I also wanted to mention a little bit about some of the main contributing factor also besides this main reason. Presence of hiatal hernia, which is a slippage of stomach into the chest, along with some common things, like diet rich in fried food, fatty food, spicy, citrus, caffeine, and chocolate, can be one of the predisposing factors, along with the lifestyle of some of the people. Eating very late at night before sleep or increased weight gain, obesity as well as diabetes have been shown to have a significant contribution towards the development of GERD.

Deborah: I'm surprised you said spicy because I thought spicy foods were really quite good for you.

Dr. Iqbal: They do impact and contribute towards acid. However, some patients or some people in our community who are used to that don't get affected with that. But they have some contribution.

Deborah: I hope I'm one of them because I adore spicy food. What are some of the warning signs that you may have GERD, and how is it usually diagnosed?

Dr. Iqbal: That's great to know, because these patients usually with symptoms I mentioned—heart burns and difficulty in swallowing—frequency of these symptoms get more and more. So the same symptoms that they were feeling once a month are coming several times a week, and now they're coming several times a day, is definitely a warning sign to see that you need to seek a physician or some expert who deals with GERD. Also, if you are seeking two or three or four pillows to sleep at night, that's also a sign of a severe GERD. Some of these patients who go and get over-the-counter medication for acid suppression feel that they have only marginal results with that and relief with that. That's also a very major warning sign. The way it is diagnosed is actually very simple. There are two tests required to diagnose GERD. Both are done in 10 minutes, and in both tests, patients usually have a short sleep. One is upper endoscopy, wherein we put a camera and visualize the upper digestive system. It helps us in knowing if there is a presence of large hiatal hernia or how much the damage is done by the acid in the digestive system. The second is also a test which is done in less than five minutes. It's Bravo capsule placement, which is a small wireless transmitter that we place in the bottom of the esophagus. Incredible results are shown after 48 hours that determines sometimes from mild, moderate, to severe disease and how much was the acid exposure of patients during that time.

Deborah: How do you get that tiny camera into the human?

Dr. Iqbal: It's done with the same endoscope once we perform the endoscopy. We just direct and place and deploy the capsule right at the bottom of the esophagus, and then the patient goes home with a small black machine that records the acid exposure.

Deborah: Incredible. Well, that's kind of the bad news. You have GERD, now you're diagnosed. So what are some of the emerging surgical technologies that are available now to treat GERD, and what are the main differences between using those conventional treatment methods?

Dr. Iqbal: The principle of the surgical repair is to treat the cause, and the cause is malfunctioning sphincter. That's done by wrapping the top part of the stomach around the esophagus and reconstructing this valve. That's the principle. Now, the technique has emerged significantly over the last 10 years. Initially started as an open procedure, the procedure name is Nissen fundoplication. It was done with an open large cut, and the patient used to have a longer recovery, a longer hospital stay. It changed into minimal invasive, which was a bit small little four inch incisions. You do the surgery, and the patient has much faster recovery. That advanced, too, now with da Vinci robot, where we do it with high precision and accuracy and a very fast recovery and very short hospital stay. Also, it continues to emerge. It continued to have an evolution of its own to a trans-oral, which is incision-less fundoplication through the mouth, and now, the most and latest in the current methods that has emerged is called LINX procedure. LINX is a very interesting device. It is a bracelet of tiny beads made of titanium and has the magnet inside. You place the bracelet at the bottom of the esophagus, and it acts like a sphincter, so it is tight enough to prevent the acid going backwards, and it is loose enough to let your food go down. And I think the significant difference between LINX and any other surgical procedure I just mentioned is that LINX is a simpler procedure to do. It requires very small, little incisions, and you can resume normal food a day after the surgery, which is incredible.

Deborah: Wow. That is incredible.

Dr. Iqbal: In any other procedure, you have to wait two to three weeks because you construct a valve and you have to slowly open it, and you have to slowly advance your diet. But in LINX, you actually immediately resume your next regular meal on the day after the surgery.

Deborah: So da Vinci and LINX are really the game changers.

Dr. Iqbal: Yes, exactly.

Deborah: How frequently, doctor, do you see people with extreme cases of GERD that you need surgical treatment?

Dr. Iqbal: More and more variance developing in the population and community, and as I mentioned, 25 million people are suffering from GERD so that about 5 to 7 percent of that is. We see a lot of patients who have been on medications for a long time and still have marginal results, so the frequency is increasing, the incidence is increasing. So we see actually quite often than what we used to see 10 years ago.

Deborah: Wow. I'm sorry to hear that, because there's so much good information out there about how to eat, how not to eat, and yet, it's climbing.

Dr. Iqbal: Exactly.

Deborah: What sort of complications can someone experience if GERD is not treated properly?

Dr. Iqbal: I think it's very important to consider the patients who are exposed to a prolonged acid damage over the period of years. They are prone to develop significant complications. So starting with more basic, when you do an endoscopy, you can see the damage in the form of redness, or we call it gastritis or esophagitis—from that to bleeding, from ulcer formation, scarring, and narrowing of the anatomy of the digestive system. And I think the most devastating of them is the development of Barrettes disease and early cancer, which is a pre-cancer condition that leads to the formation of esophageal cancer. Esophageal cancer, unfortunately, once it's diagnosed, it's one of the most devastating and deadly cancers in the country. It has grown in the last 10 years to about 600 percent because of the undiagnosis and because of the acid exposure on these patients which are not aware of them. The availability of over-the-counter medication has actually made people not go to the doctor. They don't feel a need. They just grab it whenever they need it, and it just ultimately leads to progressive development of, unfortunately, this condition that changes into cancer over time.

Deborah: I need to stop you there unfortunately, Dr. Iqbal. Thank you so much for taking time out of your day to talk to us about GERD and some great new technologies in treatments. To listen to the podcast or for more information, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have a fantastic day.