Short and Longterm Outcomes of Endoscopic Anti Reflux Procedures

All four of the FDA cleared and approved devices either have completed sham trials (Stretta, EndoCinch, Enteryx-European) or have them underway (Plicator, Enteryx-United States) and in general the success rates with these devices in these studies is 60-70%.57,58,60,65-69 Previous uncontrolled studies of endoscopic anti-reflux devices indicated clinical response rates of 90% or more, but these earlier studies' results are not nearly as reliable

MANAGING FAILED ANTI-REFLUX THERAPY

as the data we are deriving from the sham-controlled studies because uncontrolled trials tend to overestimate treatment effect. Furthermore, the endpoint of many of these early trials was less than optimal because the primary endpoint for success was often a decrease, not elimination of proton pump inhibitor (PPI) use. It must also be appreciated that both the preliminary studies and the newer sham-controlled trials only enrolled patients with GERD that were responsive to PPIs and having no more than mild to moderate reflux disease determined endoscopi-cally (generally hiatus hernias <2-3 cm and nonerosive reflux disease or at most Los Angeles grade A or B erosive esophagitis). Response rates in those with more severe disease (larger hiatal hernias, or those with more severe esophagitis) or atypical symptoms (dyspepsia, cough, asthma, etc.) have not been adequately studied but likely will be less than observed in the pivotal trials that only included patients with more mild or moderate forms of GERD. However, partial improvement in reflux physiology with a prior anti-reflux surgical procedure may make patients previously thought to have anatomy not applicable for endoscopic anti-reflux therapy, now possible candidates for those procedures. Although there are no controlled trial data regarding success of these procedures in GERD patients with atypical symptoms or in those with an incomplete response to antisecretory drugs, anecdotal experience and uncontrolled observational studies suggest some success in this situation as well.

However, again it is unlikely that success rates >50% will be demonstrated in these types of patients.

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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