Dr. Starpoli's Blog

So, you think you have acid reflux?  What is acid reflux?  Why is it called acid reflux?

A new laparoscopic therapy for reflux has been recently approved for the treat of reflux.  The procedure requires laparoscopic surgery (small incisions in the abdomen) in order to place this new device at the level of the lower esophageal sphincter.  Certain limitations will occur as the result of this procedure as will be discussed.

Several news agencies recently reported concerns of the FDA over the increased risk of Clostridium difficle diarrheal illness in patients using acid lowering antireflux drugs in the treatment of gastroesophageal reflux disease (GERD).

On September 7th and October 13th, 2011, the first two combined laparoscopic and transoral antireflux procedures were performed at the New York Univerisity Langone Medical Center in New York City.

In a retrospective study from Japan, the chronic use of proton pump inhibitors (PPIs), often used in the treatment of GERD, was found to be associated with a greater than 3-fold increased risk of developing Clostridium difficile–associated diarrhea (CDAD), Takatoshi Kitazawa, MD, assistant professor at Teikyo University in Tokyo, Japan, reported during a poster session at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy.

 
A report was published in the May 18 issue ofA report was published in the May 18 issue of Journal of the American Medical Association. In, what is referred to as the LOTUS (Long-Term Usage of Esomeprazole vs Surgery for Treatment of Chronic GERD) study, remission rates at five years were 92% (95% CI 89 to 96) for patients on esomeprazole and 85% (95% CI 81 to 90, P=0.048) for those who had laparoscopic antireflux surgery, according to Jean-Paul Galmiche, MD, of Nantes University in France, and colleagues. 

Over the last few years, new studies have been released that indicate that the long-term use of PPI drugs to treat GERD may be detrimental to some patients. Most recently, the FDA warned that long-term use of PPI’s can be linked to magnesium depletion. See below:

As reported in MedWire (12/31, Albert) reported that after reviewing 16 studies, UK researchers concluded "that the prevalence of gastroesophageal reflux disease (GERD) does not increase with age, but that esophageal symptoms of sufferers become more severe as they get older." According to the paper in Alimentary Pharmacology and Therapeutics, the "largest of these studies (n=11,945) showed that the prevalence of severe reflux esophagitis increased significantly with age from 12% in those younger than 21 years to 37% in those aged 70 years or above," but "heartburn was less common in older than younger GERD patients." Investigators also pointed out that "esophageal 24-hour acid exposure time increased by 1.1% for each additional decade in age," while "ineffective esophageal motility increased and abdominal lower esophageal sphincter length decreased with age."