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Influence of Radiofrequency Energy Delivery at the Gastroesophageal Junction (the Stretta Procedure) on Symptoms, Acid Exposure, and Esophageal Sensitivity to Acid Perfusion in Gastroesophagal Reflux Disease

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Abstract

Several studies have demonstrated that radiofrequency energy delivery at the gastroesophageal junction (the Stretta procedure) induces symptom relief in gastroesophageal reflux disease (GERD), although improvement of acid exposure on pH monitoring was usually limited. A role for decreased esophageal sensitivity has been suggested. Our aim was to evaluate the influence of Stretta on symptoms, acid exposure, and sensitivity to esophageal acid perfusion in GERD. Thirteen patients with established proton pump inhibitor (PPI)-dependent GERD (three males; mean age, 51±10 years) participated in the study. Before and 6 months after the procedure symptom score, pH monitoring and Bernstein acid perfusion test were performed. The latter was done by infusing HCl (pH 0.1) at a rate of 6 ml/min 15 cm proximal to the gastroesophageal junction for a maximum of 30 min or until the patients experienced heartburn. Results were compared by Student’s t-test. Stretta procedure time was 51±4 min and no complications occurred. After 6 months, the symptom score was significantly improved (12.5±2.0 to 7.5±2.1; P<0.05), seven patients no longer needed daily PPI, and acid exposure was significantly decreased (11.6%±1.6% to 8.5%±1.8% of time pH<4; P<0.05). The time needed to induce heartburn during acid perfusion decreased from 9.5±2.3 to 18.1±3.4 min (P=0.01), and five patients became insensitive to 30-min acid perfusion, versus none at baseline (P=0.04). In conclusion, the Stretta procedure induces subjective improvement of GERD symptoms and decreases esophageal acid exposure. In addition, esophageal acid sensitivity is decreased 6 months after the Stretta procedure. The mechanism underlying this finding and its relevance to symptom control require further studies.

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References

  1. Wienbeck M, Barnert J (1989) Epidemiology of reflux disease and reflux esophagitis. Scand J Gastroenterol 24 (Suppl 56):7–13

    Google Scholar 

  2. Locke GR 3rd, Talley NG, Fett SL, Zinsmmeister AR, Melton LJ 3rd (1997) Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County. Gastroenterology 112:1448–1456

    Article  PubMed  Google Scholar 

  3. Lagergren J, Bergström R, Lindgren A, Nyren O (1999) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831

    Article  PubMed  CAS  Google Scholar 

  4. Bardhan KD (1999) The role of proton pomp inhibitors in the treatment of gastroesophageal reflux disease. Aliment Pharmacol Ther Suppl 1:15–25

    Google Scholar 

  5. Leite L, Johnston B, Just R, Castell D (1996) Persistent acid secretion during omeprazole therapy: a study of gastric acid profiles in patients demonstrating failure of omeprazole therapy. Am J Gastroenterol 91(8):1527–1531

    PubMed  CAS  Google Scholar 

  6. Beldi G, Glattli A (2002). Long-term gastrointestinal symptoms after laparoscopic Nissen fundoplication. Surg Laparosc Endosc Percutan Techn 12(5):316–319

    Article  Google Scholar 

  7. Lundell L (2002) Protagonist. Laparoscopic fundoplication is the treatment of choice for gastro-oesophageal reflux disease. Gut 51:468–472

    Article  PubMed  CAS  Google Scholar 

  8. Galmiche J, Zerbib F (2002) Antagonist. Laparoscopic fundoplication is the treatment of choice for gastro-oesophageal reflux disease. Gut 51:472–272

    Article  PubMed  CAS  Google Scholar 

  9. Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, Raufmann JP, Sampliner R, Schnell T, Sontag S, Vlahcevic ZR, Young R, Williford W (2000) Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease. JAMA 285(18):2331–2338

    Article  Google Scholar 

  10. Vakil N, Shaw M, Kirby R (2003) Clinical effectiveness of laparoscopic fundoplication in a U.S. community. Am J Med 114:1–5

    Article  PubMed  Google Scholar 

  11. Utley DS, Kim M, Vierra MA, Triadafilopoulos G (2000) Augmentation of lower esophageal sphincter pressure and gastric yield pressure after radiofrequency energy delivery to the gastroesophageal junction: a porcine model. Gastrointest Endosc 52:81–86

    Article  PubMed  CAS  Google Scholar 

  12. Triadafilopoulos G, DiBaise JK, Nostrant TT, Stollman NH (2002) The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Gastrointest Endosc 55(2):149–156

    Article  PubMed  Google Scholar 

  13. DiBaise JK, Brand RE, Quigley EM (2002) Endoluminal delivery of radiofrequency energy to the gastroesophageal junction in uncomplicated GERD: efficacy and potential mechanism of action. Am J Gastroenterol 97(4):833–842

    Article  PubMed  Google Scholar 

  14. Corley DA, Katz P, Wo J, et al. (2003) Temperature controlled radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD (the Stretta procedure): a randomized, double-blind, sham controlled, multi-center clinical trial. Gastroenterology 125:668–676

    Article  PubMed  Google Scholar 

  15. Houston H, Khaitan L, Holzman M, Richards WO (2003) First year experience of patients undergoing the stretta procedure. Surg Endosc 17:401–404

    Article  PubMed  CAS  Google Scholar 

  16. Kim MS, Holloway RH, Dent J, Utley DS (2003) Radiofrequency energy delivery to the gastric cardia inhibits triggering of transient lower esophageal sphincter relaxation and gastroesophageal reflux in dogs. Gastrointest Endosc 57(1):17–22

    Article  PubMed  Google Scholar 

  17. Tam W, Schoeman M, Zhang Q, Dent J, Rigda R, Utley D, Holloway R (2003) Delivery of radiofrequency energy to the lower esophageal sphincter and the gastric cardia inhibits transient lower esophageal sphincter relaxations and gastroesophageal reflux in patients with reflux disease. Gut 52:479–485

    Article  PubMed  CAS  Google Scholar 

  18. Kahrilas P (2003) Radiofrequency energy treatment of GERD. Gastroenterology 25:970–973

    Article  Google Scholar 

  19. Howard PJ, Maher L, Pryde A, Heading RC (1991) Symptomatic gastro-oesophageal reflux, abnormal oesophageal acid exposure, and mucosal acid sensitivity are three separate, though related, aspects of gastro-oesophageal reflux disease. Gut 32:128–132

    PubMed  CAS  Google Scholar 

  20. Shi G, Bruley des Varannes S, Scarpignato C, Le Rhun M, Galmiche JP (1995) Reflux-related symptoms in patients with normal oesophageal exposure to acid. The acid hypersensitive oesophagus. Gut 37:457–464

    PubMed  CAS  Google Scholar 

  21. Rodriguez-Stanley S, Earnest DL, Greenwood-Van Meerveld B, Maton P, Miner PB, Robinson M (1999) Esophageal hypersensitivity may be a major cause of heartburn. Am J Gastroenterol 94:628–631

    Article  PubMed  CAS  Google Scholar 

  22. Savary M, Miller G (1977) L’oesophage. Manuel et Atlas d’Endoscopie. Verlag Gassmann, Solothurn

    Google Scholar 

  23. Koek GH, Sifrim D, Lerut T, Janssens J, Tack J (2003) The effect of the GABAb agonist baclofen in patients with symptoms and duodenogastro-esophageal reflux refractory to proton pump inhibitors. Gut 10:1397–1402

    Article  Google Scholar 

  24. Tack J, Bisschops R, Koek GH, Sifrim D, Lerut A, Janssens J (2003) Dietary restrictions during ambulatory monitoring of duodeno-gastro-esophageal reflux. Dig Dis Sci 48:1213–1220

    Article  PubMed  CAS  Google Scholar 

  25. Lord SM, Bogduk N (2002) Radiofrequency procedures in chronic pain. Best Pract Res Clin Anaesthesiol 16:597–617

    Article  PubMed  Google Scholar 

  26. Kertes P, Kalman J, Edis B, Chen JM, Byrgiotis S, Kelly P, Tonkin A, Wilkinson J (1993) Radiofrequency catheter ablation of tachyarrhythmias–adult and paediatric experience. Aust NW J Med 23:426–432

    Google Scholar 

  27. Sarkar S, Aziz Q, Woolf CJ, Hobson AR, Thompson DG (2000) Contribution of central sensitisation to the development of non-cardiac chest pain. Lancet 356(9236):1154–1159

    Article  PubMed  CAS  Google Scholar 

  28. Fass R, Naliboff B, Higa L, Johnson C, Kodner A, Munakata J, Ngo J, Mayer E (1998) Differential effect of long-term esophageal acid exposure on mechanosensitivity and chemosensitivity in humans. Gastroenterology 115:1363–1373

    Article  PubMed  Google Scholar 

  29. Orlando RC (2006) Current understanding of the mechanisms of gastro-oesophageal reflux disease. Drugs 66 (Suppl 1):1–5

    Article  PubMed  CAS  Google Scholar 

  30. Tobey NA, Carson JL, Alkiek RA, Orlando RC (1996) Dilated intercellular spaces: a morphological feature of acid reflux—damaged human esophageal epithelium. Gastroenterology 111(5):1200–1205

    Article  PubMed  CAS  Google Scholar 

  31. Caviglia R, Ribolsi M, Maggiano N, Gabbrielli AM, Emerenziani S, Guarino MP, Carotti S, Habib FI, Rabitti C, Cicala M (2005) Dilated intercellular spaces of esophageal epithelium in nonerosive reflux disease patients with physiological esophageal acid exposure. Am J Gastroenterol 100:543–548

    Article  PubMed  Google Scholar 

  32. Calabrese C, Bortolotti M, Fabbri A, Areni A, Cenacchi G, Scialpi C, Miglioli M, Di Febo G (2005) Reversibiility of GERD ultrastructural alterations and relief of symptoms after omeprazole treatment. Am J Gastroenterol 100:537–542

    Article  PubMed  CAS  Google Scholar 

  33. Matthews PJ, Aziz Q, Facer P, Davis JB, Thompson DG, Anand P (2004) Increased capsaicin receptor TRPV1 nerve fibres in the inflamed human oesophagus. Eur J Gastroenterol Hepatol 16:897–902

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

    J. Arts, D. Sifrim, P. Rutgeerts, J. Janssens & J. Tack

  2. Department of Thoracic Surgery, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium

    A. Lerut

  3. Center for Gastroenterological Research, K.U. Leuven, 49 Herestraat, 3000 Leuven, Belgium

    J. Tack

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  1. J. Arts
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  2. D. Sifrim
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  3. P. Rutgeerts
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  4. A. Lerut
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  5. J. Janssens
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  6. J. Tack
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Correspondence to J. Tack.

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Arts, J., Sifrim, D., Rutgeerts, P. et al. Influence of Radiofrequency Energy Delivery at the Gastroesophageal Junction (the Stretta Procedure) on Symptoms, Acid Exposure, and Esophageal Sensitivity to Acid Perfusion in Gastroesophagal Reflux Disease. Dig Dis Sci 52, 2170–2177 (2007). https://doi.org/10.1007/s10620-006-9695-y

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  • DOI: https://doi.org/10.1007/s10620-006-9695-y

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