LINX®, a novel treatment for patients with refractory asthma complicated by gastroesophageal reflux disease: a case report

Abstract

BackgroundGastroesophageal reflux disease is one of the most common comorbidities in patients with asthma. Gastroesophageal reflux disease can be linked to difficult-to-control asthma. Current management includes gastric acid suppression therapy and surgical antireflux procedures. The LINX® procedure is a novel surgical treatment for patients with gastroesophageal reflux disease refractory to medical therapy. To the best of our knowledge, we report the first case of successful treatment of refractory asthma secondary to gastroesophageal reflux disease using the LINX® procedure.Case presentationOur patient was a 22-year-old white woman who met the American Thoracic Society criteria for refractory asthma that had remained poorly controlled for 5 years despite progressive escalation to step 6 treatment as recommended by National Institutes of Health-National Asthma Education and Prevention Program guidelines, including high-dose oral corticosteroids, high-dose inhaled corticosteroid plus long-acting β2-agonist, leukotriene receptor antagonist, and monthly omalizumab. Separate trials with azithromycin therapy and roflumilast did not improve her asthma control, nor did bronchial thermoplasty help. Additional consultations with two other university health systems left the patient with few treatment options for asthma, which included cyclophosphamide. Instead, the patient underwent a LINX® procedure after failure of maximal medical therapy for gastroesophageal reflux disease with the additional aim of improving asthma control. After she underwent LINX® treatment, her asthma improved dramatically and was no longer refractory. She had normal exhaled nitric oxide levels and loss of peripheral eosinophilia after LINX® treatment. Prednisone was discontinued without loss of asthma control. The only immediate adverse effects due to the LINX® procedure were bloating, nausea, and vomiting.ConclusionsLINX® is a viable alternative to the Nissen fundoplication procedure for the treatment of patients with gastroesophageal reflux disease and poorly controlled concomitant refractory asthma.

Artificial sphincters: An overview from existing devices to novel technologies

“…Magnetic AS devices: (A) LINX for the treatment of GERD (image from an open access paper), 37 (B) FENIX for the treatment of FI, 38 and (C) Patent WO2020084598 (image from the patent) 39 and endo‐urethral AUS designed by Mazzocchi et al 17 (D) for the treatment of UI.…”

Spotlight on the Linx™ Reflux Management System for the treatment of gastroesophageal reflux disease: evidence and research

“…Following the establishment of early guidelines for its application, the Linx device has been successfully used in a variety of other clinical settings. 24 – 26 The Linx procedure has since been suggested for patients who prefer surgery over long-term use of anti-reflux medications, 27 those with extra-esophageal manifestations, such as chronic cough or asthma, and those with GERD following gastric surgery. 25 …”

“…After implantation of the Linx device, her asthma was well controlled such that her steroid therapy could even be discontinued. 26 …”

The Asthma Obese Phenotype

“…Proton pomp inhibitors and histamine H2 receptor improve GERD-related symptoms and quality of life but does not influence asthma control [102]. However, improvement of symptoms in severe, selected cases was obtained from different surgical procedures [103,104]. However, the common high cholinergic tone in GERD and asthma raised the hypothesis that anticholinergic therapy could be a common solution [104].…”

“…However, improvement of symptoms in severe, selected cases was obtained from different surgical procedures [103,104]. However, the common high cholinergic tone in GERD and asthma raised the hypothesis that anticholinergic therapy could be a common solution [104]. A Cochrane systematic review provided some evidence that long-acting muscarinic antagonists added to ICS show some benefits on FEV1 [105], but prospective studies should confirm if there is also benefit in the AOP, and if this effect is higher in asthma-GERD association.…”