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Acid Reflux

With various acid reflux treatments ranging from medical therapy to newer non-surgical antireflux procedures such as EsophyX or BARD EndoCinch Suturing System, , Dr. Anthony Starpoli can help you to find the best treatment for your Acid Reflux, Heartburn, and Gastro Esophageal Reflux Disease (GERD). Dr. Starpoli specializes in endoscopic assisted, incisionless reflux therapy including the EsophyX and EndoCinch.

Acid Reflux Symptoms

  • Other Treatments for acid reflux include:
    Antacids- These can and should be used more often. Generally, antacids should be taken 30 to 60 minutes after eating and at bedtime. Liquids are preferred to tablets, with the strongest being Maalox II, Mylanta II, Gelusil II and Extra Strength Riopan.
  • Alginic Acid and Antacids- Two products, Gaviscon and Algicon, place a layer of foam over the fluid in the stomach to prevent reflux. These tablets should be chewed well and used 30 to 60 minutes after eating and at bedtime.
  • Drugs- Medicines are now available that effectively reduce and even eliminate the secretion of stomach acid and are the strength of the LES muscle. These medicines represent the most important method of treating reflux next to surgical or futuristic nonsurgical methods of correcting reflux. Other medications such as Reglan (generic- metoclopramide), and Urecholine (generic- bethanecol) directly increase the strength of the LES muscle. Unfortunately, these acid reflux drugs have certain adverse side effects and are not always helpful. Propulsid (generic- Cisapride) has been taken off the market for some time now due to it's cardiac side effects.
  • Laparoscopic Surgery- Surgery can treat reflux. Those patients who are dependent on acid lowering agents may entertain an antireflux procedure. There are patients who do not repsond to medical therapy and benefit from antireflux prcedures. Generally, however, a failure of medical therapy is not an indiction for surgery and such patients require a meticulous work-up. Prior to any corrective procedure, a patient must undergo an extensive evaluation that should include combine pH-impedance testing assessing nonacid as well as acid reflux. The objective of this surgery is to strengthen the LES muscle and remodel the gastroesophageal flap valve. Successful surgery greatly relieves and can correct severe reflux and heartburn. A method of performing anti-reflux surgery is by laparoscopic technique whereby the surgery is accomplished through tiny holes in the belly button and upper abdomen. The best known such procedure is known as the Nissen fundoplication. Recovery is quicker with this laparoscopic technique. However, the procedure is still an invasive surgery that has certain inherent risks and potential complications, and requires the use of general anesthesia. This operation should only be performed by qualified and experienced surgeons thoroughly familiar with it.
  • Transoral, Incisionless Antireflux Surgery (TIF)- As Director of Gastroesophageal Research and Endosurgery at St. Vincents Hospital Catholic Medical Center-Manhattan and an Attending in Gastroenterology at Lenox Hill Hospital in Manhattan, New York, I am pleased to present incisionless, endoscopic methods for the treatment of reflux are now available. I offer two incisionless, endoscopic assisted procedures: EsophyX and EndoCinch. EsophyX, also known as the TIF precedure, is a transoral(i.e. performed threough the mouth)incisionless, surgical procedure that is endoscopic assisted and applies suture-like fasteners that bring together eaophageal and gastric tissue to remodel the antireflux barrier and gastroesophageal flap valve with a result that is very similar to the formal laparoscopic surgical fundoplication. EndoCinch, also referred to as endoscopic fundoplication or endoluminal gastroplication, involves the use of a sewing device which attaches to the end of the video endoscope.

    This instrument assembly allows the endoscopist to carefully place stitches in the stomach below the LES (ie. junction between the esophagus and the stomach). The application of these sutures produces a pleat in the upper part of the stomach which helps reduce the pressure against the LES and decreases the amount reflux. With both of these procedure there are no surgical incisions and recovery is quicker.

    The team at St. Vincents Catholic Medical Center-Manhattan was the first center in New York to offer endoscopic assisted fundoplication. Working in conjunction with the developer and manufacturer of these incisionless systems, Lenox Hill Hospital and St. Vincents Hospital Catholic Medical Center in Manhattan have taken the lead in the diagnosis and management of gastroesophageal reflux disease offering the latest transoral, incisionless antireflux techniques. Generally, these procedures are quite effective in reducing or eliminating drug therapy for reflux and in controlling symptoms.

    Click for slides of procedure
    Click for video of procedure

Acid Reflux Treatment

Treatment for Acid Reflux Disease
• General measures the patient can take to reduce reflux are:
• Eat smaller and more frequent meals.
• Avoid eating before going to bed.
• Eliminate excessive bending, lifting, abdominal exercises, girdles and tight belts, all of which increase abdominal pressure and provoke reflux.
• If overweight, lose weight. Being overweight promotes reflux.
• Eliminate the use of nicotine (cigarettes), fatty foods, alcohol, all coffees (yes-including decaf), chocolate and peppermint.
• Elevate the head of the bed 8" to 10" by placing pillows or a wedge under the upper part of the mattress. In this way, gravity keeps stomach juices out of the esophagus while the patient sleeps. It is not enough to use two pillows under the head.
• Prescription medications - check with the physician regarding side effects of prescription drugs. Some drugs actually lower the strength of the LES muscle. These include anti-spasmotics (Levsin, Librax, Bentyl), calcium channel blocks (Procardia, Cardizem, Calan, Isoptin), anti-depressants (Elavil, Doxepia) and others.

For Acid Reflux Repair
Endoscopic Assisted, Incisionless Therapy For GERD

Endoscopic Assisted Reflux Therapy including EsophyX and EndoCinch are exciting incisonless surgical methods used by Dr. Anthony Starpoli to treat Gastro Esophageal Reflux Disease (GERD). This treatment is a breakthrough alternative to life-long medical therapy or invasive and costly surgery.

If you would like to find out more about solving your reflux and heartburn problems using non-invasive, incisionless procedures such as EsophyX and EndoCinch, please click here for more details. Click here should go to http://www.starpoli.com/endoscopic.html


Additional Resource Material

Learn more about EndoCinch!

The Facts about Barretts Esophagus....

Learn about the current guidelines for the management of Barrett's Esophagus:

BARRX Ablation Procedure

The BARRX System for treating Barrett's Esophagus

Treating Barrett's with RFA Ablation