Document Detail


Gastroparesis associated with gastroesophageal reflux disease and corresponding reflux symptoms may be corrected by radiofrequency ablation of the cardia and esophagogastric junction.
MedLine Citation:
PMID:  18437485     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Reflux is a common medical condition with symptoms ordinarily controlled using drug/medical therapy. However, 20% of patients experience unmanageable symptoms despite twice-daily (BID) proton pump inhibitor (PPI) therapy. Growing clinical evidence shows that delayed gastric emptying (gastroparesis) may be a factor associated with severe reflux, dyspepsia, or both. Gastroparesis, concomitant in 25% of patients with gastroesophageal reflux disease (GERD), has been shown to improve after Nissen fundoplication. Radiofrequency treatment for GERD potentially corrects GERD-associated gastroparesis and resultant PPI BID reflux failures. METHODS: From July 2000 until July 2004, 227 patients undergoing Stretta for GERD were screened for gastric anomalies. Patients with gastroparesis, documented on a standardized nuclear gastric emptying scans, and patients with heartburn and regurgitation uncontrolled by PPI BID medications underwent radiofrequency ablation of the cardia and esophagogastric junction via the Stretta procedure. The patients had esophagogastroduodenoscopy and/or pH studies, manometry, solid-phase gastric emptying, and electrogastrography and completed standardized heartburn and health-related quality-of-life surveys before treatment, then 6 months afterward. Patients with pyloric obstruction and those taking motility agents were excluded from the study. Gastric emptying scans were repeated 6 months after Stretta. The nuclear radiologist was blinded to the study design. RESULTS: At baseline, 31 patients were classified as abnormal. At 6 months after the procedure, emptying scores had improved significantly, with the percentage of solid food emptied at 90 min improved from 41% to 66% (p < 0.0001) and at 120 minutes from 55% to 84%. Significant improvements were seen at all intervals. Overall, 23 patients (74%) experienced normalization of gastric emptying, and 4 patients were improved but remained abnormal. Four patients showed no improvement on their gastric emptying scans, with one patient electing to undergo a Nissen procedure. All the patients had a 1-year symptom follow-up assessment, which showed significant improvements in GERD health-related quality of life, dyspepsia, and heartburn scores. CONCLUSIONS: Radiofrequency treatment has been demonstrated to correct gastroparesis. Patients' symptoms improved significantly. The mechanism of action is unknown but may be related to reduction in transient lower esophageal sphincter relaxations (TLESRs), increased esophagogastric junction barrier, decreased esophageal venting, alteration of the gastric pacemaker function in the region of radiofrequency therapy administration, removal of medications for symptoms, or a combination of all these.
Authors:
Mark D Noar; Emmanuelle Noar
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Publication Detail:
Type:  Journal Article     Date:  2008-04-24
Journal Detail:
Title:  Surgical endoscopy     Volume:  22     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-15     Completed Date:  2009-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  2440-4     Citation Subset:  IM    
Affiliation:
The Heartburn and Reflux Study Center, Endoscopic Microsurgery Associates, 7402 York Road, Towson, MD 21204, USA. mnoar@gastro-doc.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Analysis of Variance
Esophageal pH Monitoring
Esophagogastric Junction / physiopathology*,  surgery*
Esophagoscopy
Female
Fundoplication / methods
Gastroesophageal Reflux / drug therapy,  physiopathology*,  surgery*
Gastroparesis / physiopathology*,  surgery*
Humans
Male
Manometry
Middle Aged
Proton Pump Inhibitors / therapeutic use
Quality of Life
Questionnaires
Treatment Outcome
Chemical
Reg. No./Substance:
0/Proton Pump Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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