Magnetic Sphincter Augmentation Can Relieve Regurgitation in GERD
Laparoscopic magnetic sphincter augmentation (MSA) can be more effective than proton pump inhibitors (PPIs) in relieving regurgitation in patients with gastroesophageal reflux disease (GERD), according to a new study1.
PPIs are often ineffective in alleviating regurgitation symptoms since they do not restore a weak lower esophageal sphincter.
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Dr Reginald Bell from the Institute of Esophageal and Reflux Surgery in Englewood, Colorado, and colleagues evaluated data on 152 participants aged 21 years or older with GERD and moderate-to-severe regurgitation, despite 8 weeks of once-daily PPI therapy.
Participants were previously randomly assigned to receive twice-daily PPIs (20 mg omeprazole) or laparoscopic MSA—the MSALINX Reflux Management System from the Johnson & Johnson Medical Devices Companies2.
Both at baseline and at 6 months, researchers performed ambulatory esophageal reflux monitoring and provided a standardized foregut symptom questionnaire.
Efficacy was measured by relief of regurgitation, improvement in foregut questionnaire scores, decrease in esophageal acid exposure and reflux events, discontinuation of PPIs, and adverse events.
Only 10% of participants found regurgitation relief with twice-daily PPIs. Within the same 6-month timeframe, 89% of those treated with MSA said their regurgitation was relieved.
GERD–health-related quality of life scores improved by 50% in 81% of participants in the MSA group compared with 8% of participants in the PPI group.
At 6 months, a normal number of reflux episodes and acid exposures were observed in 91% and 89% of the MSA group compared with 58% and 75% in the PPI group.
Among participants in the MSA group, 28% reported transient dysphagia and 4% reported ongoing dysphagia. However, no significant adverse events were observed.
“Patients with GERD with moderate-to-severe regurgitation, especially despite once-daily PPI treatment, should be considered for minimally invasive treatment with MSA rather than increased PPI therapy,” the researchers concluded.
—Colleen Murphy
For more on Bell’s study, listen to his podcast on why PPIs may no longer be enough for GERD here.
References:
1. Bell R, Lipham J, Louie B, et al. Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial [published online July 18, 2018] Gastrointest Endosc. https://doi.org/10.1016/j.gie.2018.07.007.
2. LINX Reflux Management System significantly more effective than standard of care medical therapy in treating symptoms of GERD [press release]. Cincinnati, OH: Ethicon; October 9, 2018. https://www.ethicon.com/na/about-us/news-events/LINX-reflux-management-system-significantly-more-effective-than-standard-of-care-medical-therapy-in-treating-symptoms-of-GERD. Accessed November 15, 2018.