Radiofrequency treatment for gastroesophageal reflux disease
- George Triadafilopoulos, MD
George Triadafilopoulos, MD
- Clinical Professor of Medicine
- Stanford University School of Medicine
Standard therapy for gastroesophageal reflux disease (GERD) involves behavioral modifications and treatment with medications that reduce acid production or improve esophageal motility. Open or laparoscopic Nissen fundoplication may be chosen for those patients who do not wish to remain on an antisecretory medication, have an inadequate response to antisecretory medication, have a large hiatal hernia, or have persistence of esophagitis on medication. Esophagitis and GERD symptoms are improved or resolved after fundoplication in 76 to 98 percent of patients, while esophageal acid exposure time is normalized in approximately 90 percent of patients. (See "Surgical management of gastroesophageal reflux in adults".)
Minimally invasive alternatives to standard antireflux surgery have been developed, including the application of controlled radiofrequency (RF) energy to the lower esophageal sphincter region (Stretta procedure) . An advantage of RF treatment is that it can be used in patients with challenging anatomy . The Stretta system was approved by the US Food and Drug Administration in 2000.
This topic review will provide an overview of radiofrequency treatment for GERD. Medical and surgical treatments for GERD are discussed separately. (See "Medical management of gastroesophageal reflux disease in adults" and "Surgical management of gastroesophageal reflux in adults".)
Radiofrequency (RF) energy induces collagen contraction and has been shown to have therapeutic benefits in patients with cardiac arrhythmias, joint laxity, benign prostatic hyperplasia, and sleep-disordered breathing. Although the precise mechanisms of benefit in gastroesophageal reflux disease (GERD) are unclear, RF treatment appears to reduce postprandial transient lower esophageal sphincter relaxations and decrease compliance of the gastroesophageal junction, may decrease esophageal acid sensitivity by inducing healing of esophageal erosive disease, and may improve gastroparesis [2-4]. (See "Pathophysiology of reflux esophagitis", section on 'Transient lower esophageal sphincter relaxations'.)
One theory is that RF treatment improves symptoms of GERD through radiofrequency ablation of sensory neurons of the distal esophagus, leading to hyposensitization without an effect on pH. In a study of 13 patients undergoing pH monitoring and Bernstein acid perfusion testing, esophageal acid sensitivity was decreased six months after RF treatment . However, this hypothesis was not supported in a report of 118 patients examining the relationship between symptom improvement (GERD-health-related quality of life [HRQL] and heartburn scores, general satisfaction, daily proton pump inhibitor [PPI] use) and intraesophageal acid exposure (percent proximal and distal esophageal time with pH <4.0) six months after RF treatment . Responders to RF treatment had significant improvements in both proximal and distal acid exposure times. By contrast, non-responders had either no improvement or less improvement in proximal and distal acid exposure times. Changes in GERD-HRQL and heartburn severity positively correlated with changes in acid exposure.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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