Management of Gastroesophageal Reflux Disease (GERD)
Introducing the LINX Reflux Management System
A permanent solution for chronic reflux.
Symptoms of gastroesophageal reflux disease, or GERD, are experienced by nearly 20 percent of the U.S. population. For many people the symptoms are mild or intermittent, but millions suffer with severe or daily heartburn and regurgitation. Over time chronic reflux of gastric juice into the esophageal can cause damage that can lead to trouble swallowing or to pre-cancerous changes called Barrett’s esophagus. In some patients GERD can cause esophageal adenocarcinoma, the fastest increasing cancer in the United States.
For over 20 years Keck Medicine of USC has been in the forefront of the diagnosis and management of gastroesophageal reflux disease, Barrett’s esophagus and esophageal cancer. The traditional surgical therapy for GERD, a laparoscopic Nissen fundoplication, is extremely effective and renders nearly all patients free of their reflux symptoms. However, a Nissen fundoplication is best suited for patients with severe reflux disease and large hiatal hernias. For those with less severe disease the Nissen was an option but many patients preferred to stay on acid suppression medications like Prilosec or Nexium to avoid the side effects associated with the Nissen procedure.
All this has now changed.
Keck Medicine of USC is proud to be one of the first to provide the new, permanent, drug-free treatment for gastroesophageal reflux disease– the LINX Reflux Management System. This procedure is specifically designed for patients with troublesome heartburn or regurgitation symptoms who do not want or need a Nissen fundoplication.
How Does The Device Work?
The LINX device, a bracelet of magnetic beads, is laparoscopically placed around the lower end of the esophagus. In this position the LINX device augments or supports the function of the native, poorly functioning, lower esophageal sphincter. Reflux from the stomach into the esophagus tends to occur after meals when the stomach is distended. The magnetic attraction between the beads of the LINX device helps prevent reflux by keeping the sphincter closed when the stomach is distended. However, the LINX device is designed so that the magnetic beads open during swallowing, and allow belching or vomiting if necessary.
The procedure can usually be completed in 30 minutes and patients often go home the same day.
Am I A Candidate For This Management Treatment?
As with all treatments, the LINX device is not for everyone. It is best for patients with mild to moderate reflux that cannot be adequately controlled by medication, or for patients who do not want to take life-long medication to manage their reflux disease. Patients with esophageal damage from reflux or large hiatal hernias may not be candidates for the LINX device, or may have a better outcome with a Nissen fundoplication.
There are advantages and disadvantages of the LINX procedure compared to a traditional Nissen fundoplication. Advantages of the LINX include its permanent efficacy in that the magnets never lose their force, the simplicity of the procedure, and the fact that it is reversible and the LINX device can be removed. Further, the LINX device opens to allow a belch, and performs in a more physiologic fashion than the Nissen fundoplication. However, with the LINX in place patients are advised not to have MRI scans. Prior to offering either the LINX device or a Nissen fundoplication patients are carefully evaluated to determine if GERD is present, why it is present, and whether there has been any damage to the esophagus by the GERD. After the evaluation the options for management of GERD can be fully discussed and the pros and cons of the treatment options explored in detail.