But endoscopic treatments come with some risks as well. Sometimes the benefits of endoscopic procedures may not last over the long term, resulting in a resurgence of symptoms and the need to resume drug therapy. Long-term outcomes with all endoscopic treatments remain a significant issue that is still being studied.
The procedure itself can also result in complications such chest pain and difficulty burping or swallowing if the barrier is too tight. Intestinal or abdominal pain and fever can also result.
What patients are ideal candidates to receive endoscopic treatment for GERD?
The ideal patients for endoscopic therapy are those who are doing well with medical and lifestyle therapies for GERD, but want an alternative to long-term medication use. Often patients will seek out endoscopic treatments after drug therapies and lifestyle remedies have failed. Unfortunately, these patients may not respond well to endoscopic treatments either, and might be better served by instead looking for other underlying problems that might be causing the poor response.
Is there an improved relapse rate in patients who receive endoscopic treatment?
Patients who receive endoscopic treatments typically do very well. Depending on the technique, up to 100% of patients will be able to reduce or discontinue their medication, with results typically sustained for 48 months or longer from treatment. However, as mentioned, some patients do see their results wane over the long term.
Where do you think endoscopic treatments fit in with current GERD treatment guidelines? Should they be used as a monotherapy or in combination with drug therapy?
Endoscopic treatment is not first-line therapy for GERD for most patients. Physicians should first prescribe lifestyle changes and medication. These relatively simple solutions will be effective in the vast majority of people. Endoscopic treatment should be considered when people either cannot tolerate drug therapy or are looking for a long-term alternative to drug treatment. For more information from the American Society for Gastrointestinal Endoscopy on GERD, see their website at www.asge.org.
1. W. Steven Pray. Updates in nonprescription therapy for heartburn and GERD. U.S. Pharmacist. Available at: http://www.uspharmacist.com/content/d/feature/c/16135/. Accessed on Aug. 8, 2012. Resources
2. Mark Scott and Aimee R. Gelhot. Gastroesophageal Reflux Disease: Diagnosis and Management. American Family Physician. Available at: http://www.aafp.org/afp/1999/0301/p1161.html. Accessed on Aug. 4, 2012.