Clinical course of gastroesophageal reflux disease and impact of treatment in symptomatic young patients

Bonavina, Luigi; Fisichella, P. Marco; Gavini, Sravanya; Lee, Yeong Yeh; Tatum, Roger P.

doi:10.1111/nyas.14350

Cited by 11 publications

(7 citation statements)

References 118 publications

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“…This is consistent with the study by Ayazi et al 22 who found that male sex was also an independent predictive factor. The fact that MSA is more effective in younger and male patients is of particular interest because this operation may have a profound impact on the course of GERD if performed in an earlier disease stage 23 . In addition, a recent population-based study showed lower recurrence rates after fundoplication in young men who would otherwise require several decades of PPI therapy 24 .…”

Section: Discussionmentioning

confidence: 99%

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease

Ferrari

Asti

Lazzari

et al. 2020

Sci Rep

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The magnetic sphincter augmentation (MSA) device has been proven safe and effective in controlling typical reflux symptoms and esophageal acid exposure for up to 6-year follow-up. Longer term outcomes have not been reported yet. A prospectively maintained database was reviewed to assess long-term safety and efficacy of the laparoscopic MSA procedure at a single referral center. Gastro-Esophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL), use of proton-pump inhibitors (PPI), and esophageal acid exposure were compared to baseline. Favorable outcomes were defined as ≥ 50% improvement of GERD-HRQL total score and PPI discontinuation. Between March 2007 and March 2020, 335 patients met the study inclusion criteria, and 124 of them were followed from 6 to 12 years after surgery (median 9 years, IQR 2). Mean total GERD-HRQL score significantly improved from 19.9 to 4.01 (p < 0.001), and PPI were discontinued by 79% of patients. The mean total percent time with pH < 4 decreased from 9.6% at baseline to 4.1% (p < 0.001), with 89% of patients achieving pH normalization. Independent predictors of a favorable outcome were age at intervention < 40 years (OR 4.17) and GERD-HRQL score > 15 (OR 4.09). We confirm long-term safety and efficacy of MSA in terms of symptom improvement, decreased drug dependency, and reduced esophageal acid exposure. The global burden of gastroesophageal reflux disease (GERD) is enormous, with a pooled prevalence of 13.3% in community-based studies 1. Symptoms and complications of GERD persist in up to 40% of patients treated with proton-pump inhibitors (PPI) 2,3 , and fundoplication is largely underused because of the steep learning curve and reported variability in outcomes 4. The aim of fundoplication is to restore lower esophageal sphincter (LES) function by remodeling the esophagogastric junction 5. Both total (Nissen) and partial (Toupet) fundoplication procedures require mobilization of the gastric fundus to be wrapped around the distal esophagus 6. To further enhance the antireflux barrier, a crural diaphragmatic repair is routinely added 7. Currently, the fact that fundoplication is offered to less than 1% of the GERD population may have an impact on the progression of symptoms and the development of Barrett's esophagus 8. The magnetic sphincter augmentation (MSA) procedure (Linx Reflux Management System, Ethicon, Johnson & Johnson, Shoreview, Mn, USA) was developed as a less disruptive and more standardized and reproducible laparoscopic surgical option for the treatment of GERD. The MSA device is composed by a variable number of interlinked titanium beads with a magnetic core inside. This ring-like system produces a magnetic force that augments the LES. The first feasibility trial and a large prospective nonrandomized study were published in 2008 9 and 2013 10 , respectively. The MSA procedure has been granted approval for clinical use by the Food and Drug Administration in 2012. Previous reports from our group have shown feasibility, safety, and efficacy of the MSA procedure...

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Section: Discussionmentioning

confidence: 99%

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease

Ferrari

Asti

Lazzari

et al. 2020

Sci Rep

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“…On the other hand, the higher rate of crural repair associated with MSA implantation in patients with severe GERD may explain the significantly higher rate of post-operative dysphagia observed in these individuals. In fact, crural repair has an additive effect on LES augmentation, and the combination of hiatoplasty and MSA may increase the incidence of post-operative dysphagia ( 26 , 27 ). Last but not least, there were no significant differences between the two patient groups regarding the post-operative rates of recurrent hiatal hernia, endoscopic dilation, and laparoscopic device removal.…”

Section: Discussionmentioning

confidence: 99%

“…Although there was a trend toward an abnormally higher post-operative score in the severe GERD group, the majority of these patients reached pH normalization. Despite the fact that even patients with severe GERD may benefit from MSA, we hypothesize that an earlier surgical intervention has the potential to prevent anatomical deterioration of the esophago-gastric barrier and Barrett's mucosal changes ( 26 ). In two recent studies, age younger than 40-45 years, male sex, GERD-HRQL total score >15, and abnormal DeMeester score were independent predictors of favorable outcome after MSA ( 5 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

et al. 2021

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Introduction: Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease.Methods: A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure <5 mmHg, distal esophageal amplitude <30 mmHg, Barrett's metaplasia, stricture or grade C-D esophagitis, and/or DeMeester score >50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group.Results: Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (p < 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score.Conclusion: Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.

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“…A decline in the use of surgical fundoplication has been noted in the US over the past decade [18][19][20]. Further, early recognition and treatment of GERD in young patients is critical to prevent long-term complications, even in patients under continuous acid-suppressive medication [21]. Paradoxically, underuse of antireflux procedures is in contrast to the increasing recognition of GERD as a progressive disease leading to carditis, cardiac metaplasia, intestinal metaplasia, and eventually adenocarcinoma of the distal esophagus [22,23].…”

Section: Introductionmentioning

confidence: 99%

Real-world evidence with magnetic sphincter augmentation for gastroesophageal reflux disease: a scoping review

Froiio¹,

Tareq²,

Riggio³

et al. 2023

Eur Surg

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Summary Background The burden of gastroesophageal reflux disease (GERD) is high, with up to 30% of the Western population reporting reflux-related symptoms with or without hiatal hernia. Magnetic sphincter augmentation (MSA) is a standardized laparoscopic procedure for patients who are dissatisfied with medical therapy and for those with early-stage disease who would not usually be considered ideal candidates for fundoplication. The MSA device is manufactured in different sizes and is designed to augment the physiologic barrier to reflux by magnetic force. Methods An extensive scoping review was performed to provide a map of current evidence with respect to MSA, to identify gaps in knowledge, and to make recommendations for future research. All the authors contributed to the literature search in PubMed and Web of Science and contributed to summarizing the evidence. Results Magnetic sphincter augmentation, especially in combination with crural repair, is effective in reducing GERD symptoms, proton pump inhibitor use, and esophageal acid exposure, and in improving patients’ quality of life. Safety issues such as device erosion or migration have been rare and not associated with mortality. The MSA device can be removed laparoscopically if necessary, thereby preserving the option of fundoplication or other therapies in the future. Contraindication to scanning in high-power Tesla magnetic resonance systems remains a potential limitation of the MSA procedure. High-resolution manometry and functional lumen imaging probes appear to be promising tools to predict procedural outcomes by improving reflux control and reducing the incidence of dysphagia. Conclusion A consensus on acquisition and interpretation of high-resolution manometry and impedance planimetry data is needed to gain better understanding of physiology, to improve patient selection, and to pave the way for a personalized surgical approach in antireflux surgery.

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Clinical course of gastroesophageal reflux disease and impact of treatment in symptomatic young patients

Cited by 11 publications

References 118 publications

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease

Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

Real-world evidence with magnetic sphincter augmentation for gastroesophageal reflux disease: a scoping review

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