In addition to lifestyle changes, which may include dietary modification, avoiding smoking, postural adjustment, exercise (for weight loss) and the use of antacids (e.g. gaviscon, maalox, pepto-bismol), there are now 3 main treatments available for GOR:

  • Medication (usually proton-pump inhibitors or PPIs)
  • Endoscopic anti-reflux therapy (the Stretta procedure)
  • Anti-reflux surgery (laparoscopic fundoplication)
 

Proton-pump inhibitors

Proton-pump inhibitors (PPIs) are the mainstay of anti-reflux treatment. PPIs may be taken regularly (e.g. once a day, or twice a day, if reflux is more significant) or 'on-demand'. A large number of different PPIs are available, some of which may be better tolerated than others. On occasion, particularly for reflux that is difficult to control (refractory), other types of medication (e.g. prokinetics and H2-blockers) are added, to try to achieve additional symptom reduction, but this does not always help.

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Stretta Procedure

Dr Fraser was the 1st doctor in the UK to perform the Stretta endoscopic anti-reflux procedure in 2012. He was the 1st doctor in Scotland to perform Stretta (in 2016).

Stretta is a minimally invasive, endoscopic procedure that takes approximately 45-60 minutes to do. The Stretta catheter is passed through the mouth, there are no visible cuts or scars as a result of the procedure. Patients typically go home 1-2 hours after the procedure. Most patients are able to return to work and their normal activities including exercise, the day after treatment, so there is minimal interruption to everyday life.

A specially designed, flexible, catheter is passed through the mouth, into the oesophagus, and is positioned at the lower oesophageal sphincter (LOS) valve, which is located at the junction of the lower oesophagus and stomach. The catheter places 4 small needles into the muscle of the LOS and delivers radiofrequency energy to the muscle. Several areas in the region of the LOS and the top of the stomach (cardia) are treated in sequence.

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  1. The endoscopist places the Stretta catheter through the patient's mouth to the valve between the stomach and oesophagus
  2. Radiofrequency energy is delivered to the muscle of the LOS and gastric cardia over 6 treatment levels using 4 small needles, equating to 56 treatment points
  3. Over time, the LOS tissue remodels with muscle hypertrophy and reduction in LOS compliance. Clinical studies show improvement in GORD symptoms, acid exposure, and elimination or reduced use of antiacid medication

More information about Stretta is available at: www.mederitherapeutics.com

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Laparoscopic fundoplication

Anti-reflux surgery is generally done laparoscopically and has been performed for several decades. It is particularly useful for patients with large hiatus hernias, since these need to be surgically reduced during the procedure. A number of different types of fundoplication (e.g. Nissen and Toupe, full and partial wrap) are available to the surgeon, according to the needs of the patient.

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