Acid reflux, or gastroesophageal reflux, is a common condition people may experience at least once in their life. However, if it persists more than twice a week, doctors and other healthcare specialists may diagnose it as gastroesophageal reflux disease.

Gastroesophageal reflux disease, or GERD, is a chronic condition in which stomach acid and other contents move back up the esophagus.

The esophagus is a small tube that delivers food from the throat to the stomach. The stomach acid in the esophagus may cause a burning sensation as well as damage to the esophageal lining and tissues.

GERD may be more common in people who are:

• Obese and overweight
• Pregnant
• Smokers and those exposed to secondhand smoke
• Taking particular medications, such as antihistamines, asthma medications, antidepressants, sedatives, and calcium channel blockers

To relieve GERD symptoms, your doctor may recommend over-the-counter (OTC) medications like antacids. The best antacid works by reducing and neutralizing the acids in your stomach, relieving heartburn and indigestion.

However, medications alone aren’t enough to treat GERD. This encourages scientists and other medical specialists to seek novel techniques to combat chronic acid reflux. Below are the advances in GERD treatment:

1. Potassium-Competitive Acid Blockers

Potassium-competitive acid blockers (P-CABs) were developed to overcome the limitations of proton-pump inhibitors (PPIs). PPIs are medicines that can reduce stomach acid produced by the glands in the stomach lining.

PPIs were previously the first line of defense against acid-related diseases. However, they have limitations, such as:

• It requires too much time to take effect.
• It causes unwanted side effects during bedtime.
• It’s unstable when exposed to acidic conditions.

P-CABs are acid suppressant drugs that inhibit gastric H⁺ K⁺ ATPase enzyme, the proton pump located at the stomach. Compared to PPIs, they have a longer-lasting effect, a faster onset of action, and reversible acid inhibition.

Plus, P-CABs are safe and tolerable, stable in acidic conditions, can be absorbed quickly by the body, and doesn’t require an acidic environment to activate. These advantages make P-CABS a great tool to treat acid-related diseases like GERD.

2. Transoral Incisionless Fundoplication

If you’re diagnosed with GERD, your doctor or gastroenterologist may recommend a medical procedure known as transoral incisionless fundoplication to rebuild the broken passageway (valve) between your esophagus and stomach.

Transoral incisionless fundoplication (TIF) is a minimally-invasive surgery that can treat heartburn and other problems related to chronic acid reflux. But first, what do transoral and fundoplication mean?

• Fundoplication – Fundoplication means folding the fundus, or the tissue above the stomach. This prevents the stomach acid from flowing back into the esophagus by creating a barrier.
• Transoral – This means that the surgery is performed through the mouth of the patient without making any incisions.

TIF is an endoscopic procedure. It can be performed with a special TIF instrument alongside an endoscope, a flexible device inserted into the mouth, allowing surgeons to see what’s inside the body. This tool has built-in fasteners and grippers, helping doctors rebuild the passageway to create a barrier that can prevent acid reflux.

Since TIF doesn’t involve incisions, unlike laparoscopic and traditional open surgeries, the entire procedure is faster and less painful.

What Is The Success Rate Of the TIF Procedure?

TIF has an extremely high success rate of 99%. However, you may experience some minor concerns during and after the surgery, such as internal bleeding, swelling, or tear. But there’s nothing to worry about because such issues are less likely to occur.

TIF provides symptom relief that may last up to 10 years. When the symptoms return, all you need is to repeat the procedure or try other treatment options, such as taking P-CABs.

3. Magnetic Sphincter Augmentation

GERD is a chronic, progressive disease characterized by a damaged lower esophageal sphincter (LES), allowing stomach acid to flow back into the esophagus.

LES is a muscle located at the intersection between the stomach and the esophagus. It acts as a natural barrier against acid reflux and allows food and other fluids to pass through the stomach. For those diagnosed with GERD, their LES becomes weak, allowing acids to flow back into the stomach, causing damage to the esophageal lining and other symptoms, such as sore throat, cough, heartburn, and chest pain. This is where magnetic sphincter augmentation comes in.

Magnetic sphincter augmentation (MSA) is a minimally invasive procedure that can help treat GERD. It can be done using a special device called the LINX Reflux Management System. This instrument treats GERD by augmenting LES using magnetic sphincters.

LINX magnetic sphincters are made of rare Earth magnets sealed in titanium casings and coated in parylene. These magnets are structured like a dumbbell, creating an arch that allows them to sit with other magnets without touching them.

When the magnets are implanted, they’ll sit outside the esophagus without putting any pressure on the surrounding tissue. When you swallow, the implants will open to allow food and fluids to enter the stomach.

If the implanted device is closed, so does the LES, minimizing gastric pressure and preventing reflux. If you’re interested in this novel technique, ask your doctor and see if you’re a good candidate for this procedure.

4. Robotic Surgery

If your gastroenterologist recommends a surgical operation, you may consider the da Vinci surgery—a minimally-invasive, robot-assisted surgical procedure. This allows doctors to operate with superior accuracy, vision, and dexterity on the affected area.

The da Vinci surgery uses smaller instruments compared to other surgical operations. This ensures a quick healing process, smaller incisions, minimal pain and scarring, reduced blood loss, and less stress on the body.

Most GERD patients who have undergone robotic surgery go home after the procedure and return to their daily routines much faster than expected. If you’re interested, consult your gastroenterologist and find out whether you’re a good candidate for this surgery.

5. Electrical Stimulation Therapy

Electrical stimulation therapy (EST) is an effective and safe way to treat GERD. It’s done by increasing the pressure through constant stimulation, helping patients, especially those unsatisfied with acid suppressant drugs and concerned with the risks and complications of fundoplication procedures.

During the procedure, the doctor will implant a special device called an electrical stimulator. This involves minimal incisions on the abdominal esophagus using ultrasound-based methods. The main goal of EST is to boost the barrier ability of LES for more manageable reflux while maintaining normal LES anatomy and function.

Final Words

GERD is a chronic condition caused by recurrent acid reflux or heartburn. Scientists have been working non-stop to develop novel techniques to treat GERD effectively and efficiently. This leads to significant advancements in GERD treatment, such as P-CAB medications and other minimally-invasive procedures like TIF, MSA, EST, and robotic surgery.