How to Manage PPI-Refractory Regurgitation
Prateek Sharma, MD, FASGE reviewing Bell R, et al. Clin Gastroenterol Hepatol 2019 Sep 10.
Magnetic sphincter augmentation (MSA) uses a series of titanium beads that augment the lower esophageal sphincter, thereby leading to improvement in gastroesophageal reflux. This minimally invasive surgical procedure has been proposed as an alternative to fundoplication, the standard treatment of gastroesophageal reflux disease (GERD).
The current study is a follow-up of the initial randomized controlled trial comparing the effectiveness of laparoscopic MSA versus twice-daily proton pump inhibitor (PPI) therapy in patients with moderate to severe regurgitation. Patient symptoms, esophageal acid exposure, and adverse events were evaluated at baseline and 12 months. Control of regurgitation symptoms at 1 year was achieved in 96% of patients (72/75) who had undergone MSA, compared to 19% (8/43) treated with PPI therapy. Furthermore, of the GERD patients treated with MSA, 81% had improvement in GERD-related quality of life, 91% discontinued PPI therapy, and 70% had pH normalization. No significant perioperative events, including device explantation or migration, were noted.
COMMENT
In GERD patients, regurgitation is the symptom that is difficult to control with PPI therapy, even after dose escalation. Laparoscopic MSA appears to be a reasonable option to consider in this patient population, although controlled data are available from only 1 year at this time.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Prateek Sharma, MD, FASGE
CITATION(S)
Bell R, Lipham J, Louie BE, et al. Magnetic sphincter augmentation superior to proton pump inhibitors for regurgitation in a 1-year randomized trial. Clin Gastoenterol Hepatol 2019 Sep 10. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2019.08.056)
