What alternatives are there for those who suffer from severe GER, but
for whom surgery has been unsuccessful.

---

Request for Question Clarification by knowledge_seeker-ga on 28 Nov 2002 17:04 PST

Hi pumpkinpie,

Are you looking for information on adults, children or infants?

-K~

---

Clarification of Question by pumpkinpie-ga on 28 Nov 2002 17:22 PST

Adults, please (seniors).  Thanks.

---

Clarification of Question by pumpkinpie-ga on 28 Nov 2002 17:26 PST

Dear I,

The adult has undergone laparoscopic (partial) nissen fundoplication surgery.

---

Clarification of Question by pumpkinpie-ga on 28 Nov 2002 21:29 PST

(I clarified my question by posting a comment.  Hope you got it)

---

Clarification of Question by pumpkinpie-ga on 29 Nov 2002 08:46 PST

Eric, 

YES! Thanks for mentioning the music CD.  I don't know why it's
closed. Strange.  Anyhow, I DEFINITELY remain interested in obtaining
the disc. So whatever info you have, please do share.   Let me know
what I need to do in order to "open" the question to comments/answers.

Re the GER: the individual has clearly been in close contact with a
gastroenterologist (he's already surgery, remember?).  Oh, and by the
way, the individual -- my dad -- happens to be a physician himself. 
Regardless, he takes medication to reduce the symptons associated with
acid reflux and does, indeed, sleep upright.

I guess I was hoping that you guys, in your research, would stumble
across experimental medication/surgery, or just something that hasn't
already been explored by my dad.

Thanks again for your help.  

I look forward to your response(s).

---

Clarification of Question by pumpkinpie-ga on 29 Nov 2002 08:50 PST

Dear Eric, 

re my search for a CD:  Do I need to ask another question in order to
have it "opened" for research?  If so, am I still obligated to pay the
$.50 charge?

---

Request for Question Clarification by voila-ga on 29 Nov 2002 11:58 PST

Is your dad aware of the STRETTA procedure?  I'm not quite sure about
its efficacy for someone status post Nissen, but maybe another
researcher with some time could investigate that for you.

http://www.pslgroup.com/dg/214da2.htm
http://www.stanthonymedicalcenter.com/intouch/spring2001/gerd.html
http://www.curonmedical.com

Hope he's feeling well after that big Thanksgiving meal,
V

---

Clarification of Question by pumpkinpie-ga on 29 Nov 2002 13:57 PST

Hey viola,

Thanks for your well wishes!  I will ask him about STRETTA and get
back to you.  Thanks, again!!!

By the way, don't know if you are aware, but I had another question re
a CD i've been looking for.  If you have time, maybe you can check it
out?  Thanks!! Hope you enjoyed your Thanksgiving!

---

Clarification of Question by pumpkinpie-ga on 29 Nov 2002 18:36 PST

Hi Surgeon and Viola (I hope you do not mind that I address you both
in the same letter of clarification),

As he explains it to me (and I hope that I understood it correctly): 
the reason why the surgery was only "partial" is because my father's
esophagus/related muscles are extremely weak -- and thus, a "full"
procedure, which would overly "tighten" the muscle, would result in a
complete inability to keep food down.  (I'm not sure if I'm explaining
it correctly, otherwise, I'll just have him give you the info
directly).

Thus, Re STRETRTA, I referred my father to the web sites.  After
reviewing them, he explained that this type of a procedure is designed
for a more "classic" case of GERD, in which the esophagus hasn't been
as weakened.

By the way, the procedure took place about one year ago, here in
Manhattan. With respect to Nissen laparoscopic surgery, is one year
considered the "early days"?

p.s. VIOLA:  I'm with you:  my "small meal" rule gets tossed out the
window on Thanksgiving day!  But, tomorrow's a new day.  As it turns
out, I'm not even a fan of pumpkin pie!  I only call my sweet,
adorable little nephew that!

Thanks, both of you for your help!

Hi again nephew to pumpkinpie,

This article lists the latest procedures for treatment of GERD.  I
agree with surgeon-ga that dad will probably have to undergo a redo
procedure, but hopefully one of these new procedures will improve his
quality of life.

http://www.inpharm.com/External/InpH/1,,1-0-0-0-inp_intelligence_art-0-5411,00.html

*    "Boston Scientific and Enteric Medical Technologies have
collaborated in the development and marketing the Enteryx liquid
polymer technology.

*   Curon introduced the 60-minute Stretta procedure, which is a
minimally invasive endoscopic procedure, which delivers RF energy to
the lower esophageal sphincter to enhance the sphincter's function,
reducing the frequency of reflux events.

*    Endoscoping suturing is a new procedure that may eliminate the
need for daily medication. A flexible tube with a tiny sewing machine
at one end is inserted down the throat to stitch two pleats near the
LES. The outpatient procedure requires mild sedation and patients are
released the same day. Side effects after surgery, such as difficulty
swallowing or inability to belch or vomit, occur in 5 to 20 percent of
patients. Interestingly, a study by the UT Southwestern Medical Center
at Dallas suggests that anti-reflux surgery is not better for treating
severe heartburn than antacid medications. The researchers also found
that two thirds of the patients in the study who had surgery still
took anti-reflux medications on a regular basis. This leads one to
conclude that innovative surgery may not improve GERD over the cheaper
over-the-counter antacids, and that research and development of new
treatments in GERD is still necessary to alleviate serious cases."

-------------------

On page 8 of this 9-page document, "New Treatments for GERD"
http://www.medreviews.com/pdfs/articles/RIGD_22_Article_3.pdf 
the author describes the liquid polymer technology along with its
success rate.  Biopolymer ethylene vinyl alcohol is injected into the
lower esophageal sphincter via a sclerotherapy needle under
fluoroscopy.  On average, patient symptom scores improved 64%, 83% and
82% at 1, 3, and 6 months following the initial injection.  It's the
study author's contention that the "polymer might serve to supplement
the LES pressure and thereby restore competency to the cardia."

This procedure makes a lot of sense to me but the medical jury is
still out on this procedure.  I just don't know that I'd be all fired
up about having an ethylene vinyl alcohol biopolymer injected into my
body, although living with daily reflux is no picnic either.  If your
dad would like to read the study results, see #37 in references from
the above article.

---------------------

"Increasing Experience with Endoscopic Therapy"
http://www.medscape.com/viewarticle/430704_3 
{must register to view Medscape articles} 

----------------------

Regarding the endoscopic suturing or BARD procedure:
http://216.239.51.100/search?q=cache:oiYyEgpbOEEC:www.helioshealth.com/cgi-bin/news/news.cgi%3F161+%22Gerd%22+%22new+treatments%22&hl=en&ie=UTF-8

"The Bard Endoscopic Suturing System, the first to be approved,
enables healthcare provides to surgically “tighten” the LES and halt
the reflux of acid back into the esophagus. During the procedure, a
device similar to a miniature sewing machine is inserted down the
patient's throat. The machine ties together suturing material in two
places along the LES.  There is no cutting involved and the procedure
is over in about an hour. Patients can usually return to their usual
routine the next day."

Miniature sewing?  Yikes, I have a hard time getting down a spoonful
of Cheerios!  Your dad's esophagus may vary.

---------------------

From the sound of things, dad's way past drug therapy but here is a
list of pipeline drugs in clinical trial for GERD {search
gastroesophageal reflux disease from the drop-down menu}.  From what
I've seen, it looks as if the drug "Zelnorm" is being fast-tracked for
approval for GERD as well as for IBS.

http://centerwatch.com/patient/cwpipeline/search.asp

---------------------

This is all I've found on the GERD turnpike thus far.  Have dad take a
look and see if anything sounds promising.  I will continue to keep my
eyes open for anything relevant.  We stumble across many things in our
research travels while we're searching for other things.

Best of luck!
V

---

Clarification of Answer by voila-ga on 30 Nov 2002 10:25 PST

Correction:  "Aunt" to pumpkinpie (eye roll, what a bonehead!).  I
failed Relationships 101.

The researcher was very thorough, diligent and attentive (and, not to
mention, funny!) The information provided appears to be exhaustive on
the subject and current.  Perhaps one day there will be more options
for those who suffer from GERD.  Thanks viola!!

Is this an infant or child who has already undergone endoscopic fundalplication?

Look up gastroparesis  or gastric paresis.   A central muscle tone
exercise conditioning program (physicial therapy) did great things for
my children over the course of several years.  It included a swim
therapy program, walking and cycling.  Regular sustained exercise
improves gastric motility which in turn improves the problem of stasis
of gastric contents.

This suggestion (exercise) may be of questionable value in a senior
who may not be particularly mobile.  You did not mention the age or
general health condition of the individual in question.

There are many prescription medication remedies available, but I am
sure you would seek the advice of your physician for that.

There are also diet regimens available.  

Good luck to you.

Dear Inquiring,

I apologize for failing to provide additional information -- I wasn't
exactly sure what you would need to know.

The individual is a 63-year old gentleman who has always maintained a
very active and healthy lifestyle.  In fact, he swims and/or walks
regularly (about 4-5 times per week) and maintains a very stict diet
(low in saturated fat, high fiber, etc.).  Thus, notwithstanding the
acid reflux -- for which medication and surgery has had minimal effect
-- he is, for the most part, a healthy man.

Bottom line is, I'm wondering if he has exhausted all available
remedies, given that he has:  (1) had surgery; (2) continues to take
medication; (3) exercises regulary; and (4)  maintains a healthy diet.

Hope this was more helpful.   If you need for information, let me
know. Thanks!!

If he continues to suffer from "severe" reflux, even though he is
taking prescription remedies, he must stay in contact with his
physician and inform the physician that the Rx is not performing
satisfactorily.   Surely the doctor would strive to find an
alternative for him if the doctor was aware the Rx was not working. 
Prescription recommendations must come from his physician.

* See a specialist in Gastric issues.  GASTROENTEROLOGIST

* Consider environmental adaptations, i.e., sleep with the head of the
bed elevated.  (You did not indicate when the reflux occurs).

Hi pumpkinpie-ga,

You had another question posted to Google Answers on 11/27 regarding a
music CD. I had some information to provide you concerning that
request, but when I went to post it just now, it had been expired or
cancelled. I didn't know if that was your intent or not (perhaps
you've already found the information you wanted on your own), but once
a question is closed, no one can post new information to it. Just
thought I'd mention this in case you want to repost that question.

Yes, I certainly did, although I ate too much of your pie.  This year
I'm ultra "thankful" for the development of Nexium.  I don't know why
my mantra of "small meals, *small* meals" goes totally out the window
on turkey day. ;-)

Let me know what dad says about STRETTA.  If it's not doable, I'll
check further.  One of these procedures is probably in my future. 
They do sell a lot of products for GERD symptoms since it's quite
common and always worse at night.  Here's a humpity-dumpity pillow. 
They'd better sell pillow cases for this puppy. 
http://www.propuppillow.com/index.html  I imagine he's doing all the
lifestyle/behavioral modifications though, but these are always easier
said than done.

Since I have another lock on a question at the moment and researchers
can only pursue one question at a time, I'll have to defer on your CD
question.  It looks as if you're in very capable hands with ericynot
and knowledge_seeker.  It's kind of an unwritten code that we back off
a question when another researcher has put in considerable time and
effort.  I will keep an eye on that question though.  It looks
interesting and I'm sufficiently irate when someone messes with my
music.  grrr.

I'm curious what you meant when you described the procedure as
"partial." In the earlier days of laparascopic Nissen, an incomplete
wrap was done because it was easier. It had a pretty high failure
rate. If indeed he had a partial wrap, then there's a good chance he'd
get good relief by having it re-done. It's not as easy as the first
time around, and he'd need to see a surgeon experienced in
re-operative esophageal surgery; but it's worth considering