As reported by Medscape, according to research presented at the Digestive Disease Week meeting, “patients with gastroesophageal reflux disease (GERD) might benefit more from transoral incisionless fundoplication (TIF) than from continued treatment with proton-pump inhibitors (PPIs).” The study’s lead author Karim Trad, MD, said, “In this study, transoral incisionless fundoplication was superior to maximal-dose PPIs in eliminating daily troublesome typical and atypical symptoms in selected patients.” Dr. Trad added that the findings “establish for the first time that, for some patients, the procedure is better than maximal-dose PPI therapy for controlling a range of GERD symptoms.”
It is interesting to note that the majority of these patients studied had regurgitation as a primary symptom. Studies show that regurgitation is not managed well with acid lowering therapies. Therefore, it is understandable that a surgical approach as with the EsophyX TIF procedure would benefit this type of GERD patient. The TIF procedure remodels the gastroesophageal flap valve that enhances the antireflux barrier.
This study represents high quality data that supports the use of TIF in clinical practice. Another important point is that the TIF procedure does not carry the side effect profile associated with traditional laparoscopic fundoplication. With TIF there have been no reports of swallowing difficulty, gas-belch-bloat syndrome, or chronic diarrhea.
As newer antireflux procedures become available, one has to watch for adverse events that can be associated with the newer techniques. A significant advantage of TIF that cannot be over emphasized is that it is an incisionless procedure.
Regardless of the various therapies available, reflux requires a meticulous diagnostic evaluation that usually includes upper endoscopy, but may involve 24 hour reflux monitoring and esophageal motility testing.
While numerous articles and studies about TIF have been written, we eagerly await other prospective studies of EsophyX TIF that will provide a strong backbone of support in the recommendation of TIF as a therapeutic option for chronic reflux patients.