GERD Endotherapy

GERD is defined as the presence of symptoms (such as heartburn and regurgitation) and/or tissue damage (i.e., erosive esophagitis) secondary to reflux of normal gastric contents in the oesophagus. GERD significantly impairs quality of life, and normalizing such impairment is probably the most important endpoint in its management.

Several strategies have been used in the management of GERD, including lifestyle modification; drug therapy such as antacids, H2-receptor antagonists (H2RA), and proton pump inhibitors (PPIs); and surgery (fundoplication).
Unfortunately, some patients with GERD remain symptomatic even on PPI therapy or after surgery. This subset of patients will be around 30-40%. This subset is called PPI dependant or refractory GERD patients.

Endoscopic therapy in this group of patients GERD-related quality of life would not only improve over and above that achieved with PPIs, but hopefully would normalize the symptoms.

The best candidates for Endoscopic therapy are –

• Patients with an impaired GERD-related quality of life due to persistent heartburn despite escalating doses of PPIs.
• Patients who have residual regurgitation without heartburn while on PPIs.
• Patients with objectively demonstrable GERD who are symptomatic because they cannot tolerate PPIs.
• Patients who desire to stop drug therapy fearful of long-term sequelae.
• Patients who are symptomatic after anti-reflux therapy and who do not have a recurrent hiatal hernia or displaced fundoplication.

The patient selection is very important and since we have a world-classGI motility lab, the workup can be done meticulously.

We have different Endoscopic therapies like –

• Stretta: Radio Frequency Ablation of Lower Esophageal Sphincter (LES)
• GERD-X: Fundoplication of Gastro-Esophageal Junction

Very few centres across the world do these therapeutic procedures as it requires meticulous work up and careful selection of patients to produce best results.