Stimulation Device for Esophagus Might Ease GERD Symptoms

Three small, early studies found the device helped for at least a year

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By Alan Mozes
HealthDay Reporter

TUESDAY, Oct. 23 (HealthDay News) -- Electric stimulation of the esophagus shows promise as a novel way to provide symptom relief for patients struggling with chronic gastroesophageal reflux (GERD), three new studies suggest.

The device's effectiveness, which was tested in very small groups of patients, was measured by two independent study teams -- one American and one Dutch.

Both teams presented their findings Monday at the American College of Gastroenterology annual meeting, in Las Vegas.

The goal: to develop a new therapy for GERD patients who are reluctant to undergo more invasive stomach surgery, or for whom a lifelong regimen of acid-suppression drugs known as proton pump inhibitors is either unappealing or not particularly effective.

"Most patients who have reflux symptoms are treated by meds that suppress acid production in the stomach," explained one of the American team's co-authors, Dr. Edy Soffer, director of the Gastro-Intestinal Motility Program with the Keck School of Medicine at the University of Southern California in Los Angeles. "They continue to reflux, but minus the acid."

"But there are a fair number that are not satisfied with the results," he noted, "because they continue to have symptoms or are concerned about taking medications for the rest of their lives."

"The established alternate option is surgery, in which the stomach is wrapped around the end of the esophagus to tighten it," Soffer explained. "But while it is effective, it is a very demanding procedure that has many potential side effects, such as trouble with swallowing and burping, diarrhea and sometimes the need for a secondary and more difficult 'redo' operation."

"The number of these surgeries has actually been declining over the past number of years, and there's a need for other solutions that provide better control than acid-control medication and fewer problems than the surgical option," he added.

With that in mind, Soffer and colleague Michael Crowell, of the Mayo Clinic in Scottsdale, Ariz., explored the potential of a new laparoscopic technique, in which a pair of small electrodes are inserted in the region of the lower esophageal sphincter where the stomach meets the esophagus. In turn, these electrodes are connected to a small stimulator device, fashioned along the lines of a heart pacemaker, that is implanted into the patient's abdominal wall.

Once in place, the device is designed to send low-energy pulses to the patient's poorly functioning lower esophageal sphincter (LES). The idea is to prompt this faulty valve, cited as the principle driving force behind GERD, into doing a better job of sealing off stomach acids from the esophagus.

In two studies -- one year-long study involving 19 patients and an ongoing two-year study involving 25 patients -- Soffer, Crowell and their colleagues tracked GERD symptoms after the procedure was done.

Following implantation, electrical stimulation therapy sessions were conducted for 30 minutes daily, and continued for a year.

After a year of therapy, patients in the first study appeared to experience a "normalization" of acid uptake in their esophagus. There were also no notable adverse reactions to the implant procedure or the stimulation therapy.

Among those in the second study, more than three-quarters of the patients similarly reported acid normalization or a 50 percent drop in their use of standard GERD medications by the end of the first year.

Although the second study has one more year to go, participants already were deemed to have experienced a "significant improvement" in their health-related quality of life.

The American team concluded that the electrical stimulation approach is effective as a treatment for GERD for at least one year after implantation.

The Dutch team, led by Dr. Arjan Bredenoord from the University Medical Center Utrecht in Rotterdam, came to a similar "preliminary" conclusion.

Their ongoing study involved 11 implantation patients, who have so far undergone electrical therapy for a period of between three and six months.