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Running Rings Around Acid Reflux Disease

Abington Surgeons Outsmart GERD with Tiny Metal Ring Implant

Valerie CutlerEvery time Valerie Cutler swallows – between 500 and 1,000 times a day – a small band of magnetized beads at the base of her esophagus opens and closes, aiding in digestion. Thanks to this tiny ring of titanium-wrapped magnets, Valerie no longer suffers from the pain or limitations of gastroesophageal reflux disease (GERD) – a condition she said was controlling her life.

Specialists at the Shorday Center for Advanced Gastrointestinal Surgery at Jefferson Abington Hospital surgically implanted Valerie’s LINX® Reflux Management System in April 2015. Abington surgeons are among a handful in the Philadelphia area specialty trained in this new procedure. Acid reflux disease is a chronic condition that affects an estimated 65 million Americans. A weakened muscle at base of the esophagus allows the stomach’s fiery digestive juices to reflux (back up) into the esophagus instead of remaining in the stomach. “If not effectively treated, GERD eventually can lead to serious complications, such as strictures or ulcerations,” said Robert Josloff, MD, director, Surgical Residency Program, AH, one of two Abington surgeons who performed Valerie’s procedure.

For Valerie, who had been planning her daily schedule around GERD, LINX relieved all the symptoms that had plagued her for 20 years, and dramatically improved her quality of life. “Unless you live with chronic GERD, you have no idea how it takes over your days,” said the Philadelphia resident.

During the early onset of GERD, Valerie used over-the-counter (OTC) medications to manage stomach pain and heartburn. As is often the case with the condition, OTCs stopped working. Valerie’s doctor prescribed other medications. Over time, lifestyle changes, dietary management and medication no longer managed Valerie’s symptoms. “The acid reflux would get out of control, and it wasn’t easy living that way,” she recalled. Valerie’s case is not uncommon.

Last spring, Valerie’s gastroenterologist (a physician who specializes in managing diseases of the gastrointestinal tract and liver) at JAH, Anne Saris, MD, referred her to specialists at Abington’s CAGiS. Valerie and husband Stanley met with Kenric Murayama, MD, who at the time, served as chairman, Abington’s Department of Surgery and Dr. Josloff. (Dr. Murayama recently moved back to his native state, Hawaii, where he now serves as Chair of the Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa.)

After consulting with Dr. Murayama and Dr. Josloff, and reviewing all Valerie’s treatment options, she and Stanley decided to pursue LINX. Valerie said she chose LINX over other surgical options because it is less invasive.

Connecting the LINX

In people with GERD, the muscle where the esophagus meets the stomach is weak. Known as the lower esophageal sphincter (LES), when functioning normally, this muscle acts as the body’s natural barrier to gastric acids, preventing reflux. If the LES is weak, it allows acid and bile to flow back into the esophagus, where they can damage the esophageal lining and cause such symptoms as heartburn, chest pain, regurgitation, sore throat, and cough. For patients whose heartburn and associated complications do not respond to medical management, LINX is a new surgical option that offers lifelong treatment.

LINX procedureDrs. Murayama and Josloff performed Valerie’s minimally invasive procedure, operating through five tiny incisions in her abdomen. With specialized instruments, they placed the LINX system around the esophagus, just above the stomach. “This band helps to prevent gastric acids from pushing back up into the esophagus from the stomach,” said Dr. Josloff. “It also safely allows the LES to open when required to allow for easy swallowing, as needed.”

Delighting in the Delicious and Delectable

LINX in Gloved Hand“Since the day of my surgery, I’ve been able to cut back significantly on my medication,” said Valerie, whose symptoms have nearly disappeared. For a few months following surgery, she experienced dysphagia (pain and discomfort when swallowing) – part of the recovery process. She followed post-surgical instructions conscientiously, chewing a soft diet carefully and eating every two hours for the first month to keep scar tissue from forming at the surgical site. Gradually, Valerie resumed a normal diet.

“LINX was a terrific option for me,” said Valerie, who has become increasingly adventuresome with her food and menu selections. She’s especially thrilled to be able to enjoy once again what she considers to be staples of any diet – orange and grapefruit juices and pasta with tomato sauce.

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