Radiofrequency against heartburn

Endoscopic procedure is being investigated at the Hannover Medical School (MHH) in a long-term study

Initial results are promising: endoscopic radiofrequency therapy seems to be an alternative to previous drug treatment for heartburn. The procedure was developed by a Californian company and is currently being tested at several European clinics. The Department of Gastroenterology, Hepatology and Endocrinology of the Hannover Medical School (MHH) is one of the three German centers and has treated the most patients in Europe. So far, 25 patients have been treated by the team headed by Dr. med. Peter N. Meier supplies. The result: In the majority of patients, one treatment is enough to make them long-term symptom-free. This corresponds to the figures of a North American study with 47 patients, in which 87 percent of those affected no longer felt any symptoms after the therapy.

What is reflux?

Between the esophagus and the stomach is a closure mechanism that works like a one-way street: It lets swallowed food or liquids through and holds back the gastric contents after the passage. If the occlusion does not work anymore, gastric acid can enter the esophagus - this is medically called reflux. Typical symptoms include heartburn, acid regurgitation, sternum pain and, more rarely, cough and asthma. Chronic reflux initially leads to inflammation in the esophagus. If the reflux is prolonged, the esophagus changes - a so-called Barrett's mucosa develops. In the worst case, it can lead to cancer.

What treatment options are there?

As a standard therapy drugs are currently used: they inhibit the production of gastric acid and thereby indirectly prevent acidic stomach contents from entering the esophagus. Patients usually need to take the substances over a long period of time. A second option is surgery - but with the risks of general anesthesia. In addition, the long-term results are unsatisfactory.

What is radiofrequency therapy and how does it work?

Radiofrequency therapy is an endoscopically controlled procedure. First, a gastroscopy serves to get an accurate picture. Then a flexible tube is pushed into the esophagus. He is half the size of a normal endoscope. At the bottom of the tube is an inflatable balloon. It is inflated exactly at the transition from the esophagus to the stomach, so that it rests all around on the esophageal wall. After that, four small needles are deployed, which transmit the radio frequency energy to the tissue - comparable to a slight n warming, but without killing cells. This is repeated at short intervals at several heights. During the procedure the patients sleep; they are receiving a sedative injection shortly before. The treatment does not last longer than 40 minutes.

What does Radio Frequency Energy do?

The added energy stimulates the oesophageal wall to form new connective tissue. This narrows the space in the esophagus-stomach transition from the inside. At the same time, nerve endings are shut down, which, due to small spontaneous impulses, often cause the transition between the esophagus and the stomach to open.

What complications can occur?

The possible complications are close to those of normal gastroscopy. These may be mild impairment of well-being and intolerance reactions to the medication administered. Also very rarely, inflammation, infection or bleeding of the esophagus occur. Furthermore, on the day of therapy, a stronger feeling of pressure may occur at the transition between the esophagus and the stomach. This usually disappears within 24 hours.

What happens after the therapy?

First, the usual medication must be continued for eight weeks, so that the new connective tissue has enough time to form. After that, they will be dropped off. Now it shows whether the endoscopically controlled procedure has the desired success.

In the context of observation, patients treated with the radiofrequency procedure are cared for for at least one year. If the results continue to be positive after completing the examinations, the procedure could be used regularly in the treatment of heartburn.

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