29 April 2021 Jewish News
Tech advances help sufferers of
ne of the most common reasons people go to the GP is for treatment of indigestion. Things have changed a great deal in the past 50 years. People used to follow a white diet to try to minimise their suffering. Antacids were improved with the use of alginate medicines, which form a raft over the acidic contents of the stomach, so when they rise up into the oesophagus they don’t burn. Indeed, lifestyle measures still remain vital for many people. Simple, but less well-known changes, such as avoiding coffee, chocolate and fatty foods, can have an enormous impact. For many people, not eating late can also make all the difference between waking in up the night with heartburn or sleeping through. Despite lifestyle measures, many people need to take medicines, either intermittently or regularly. One of the mainstays of treatment for many years, ranitidine, was recently taken off the market although similar drugs are still available. These work well for people with stomach ulcers, but poorly for those with gastroesophageal reﬂux disease (GERD for short). Proton pump inhibitors are among the most widely prescribed drugs in the UK. Omeprazole or lansoprazole are the most commonly used, but other, more powerful alternatives, exist. In the Far East, there is a new class of potassium-competitive acid blockers, but these are not yet licenced in the UK. Despite the amazing advances in medical therapy, a quarter of patients suffer ongoing symptoms and need more help.The next step is some type of surgery. Traditionally, this was fundoplication, which involved wrapping the top of the stomach around itself to prevent acid reﬂuxing back into the oesophagus. But, in the past 15 years, new minimally invasive treatments have become available.
Stretta therapy strengthens the weak valve at the bottom of the oesophagus using radio frequency. It is given as a single treatment delivered by endoscopy and, in carefully chosen patients, can be very effective. The LINX System is a bracelet of magnetic beads that is placed around the lower oesophagus. As a person eats, the beads pop apart, but when the person burps, they stay together, thus minimising the likelihood of reﬂux.This minimally invasive surgical procedure has been shown to be highly effective. Even more novel is the transoral incisionless fundoplication, an endoscopic version of fundoplication.This is done as a day case with no surgical incision. Each of these surgical approaches requires careful patient selection by an expert who has done the appropriate diagnostic tests. Luckily, we have also had major advances in this area. It is now possible to precisely delineate the severity and pattern of acid reﬂux during routine endoscopy by
›››››› introduction of a new neuromuscular retraining device, the iQoro. With regular simple exercise, this is claimed to abolish the root cause of the reﬂux. The studies have not yet been done, but if it truly works, GPs may yet ﬁnd their surgeries ﬁlled with other problems instead!
numbers of patients. But technological breakthroughs are continuing apace. In the past two years, we have seen the
Technological Progress for Acid Reﬂux Professor Laurence Lovat, professor of Gastroenterology, UCL, and director, the London Gastroenterology Centre www.gastrolondon.co.uk Tel: 020 7183 7965
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BRAVO pH monitoring device adding in a simple ‘BRAVO’ pH monitoring device that is attached to the lining of the oesophagus. It records for up to four days and wirelessly sends the information to a box the patient carries with them. At the end, it automatically releases itself and is ﬂushed away. The patient does not need to retrieve it. Accurate diagnosis has enabled much better targeted treatment with improved outcomes for large
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The LINX System is a bracelet of magnetic beads placed around the lower oesophagus Antenatal_AndreaSilverman_A5_2.indd 1