A special presentation at Digestive Disease Week 2015 featured GERD experts weighing in on their successful experience using Stretta therapy to treat challenging patient populations suffering from GERD.
Ronnie Fass, MD, of Case Western Reserve University moderated the discussion, and reviewed clinical data on Stretta. Expert panelists then addressed specific types of chronic GERD patients that Stretta has helped them treat.
Dana Portenier, MD, Duke University School of Medicine
Stretta in GERD After Bariatric Surgery
Hiroshi Mashimo, MD, PhD, VA Boston Healthcare/Harvard Medical School
Stretta in LPR Patients
George Triadafilopoulos, MD, Stanford University School of Medicine
Stretta in Refractory GERD
Mark Noar, MD, Heartburn and Reflux Study Center
Stretta in GERD After Anti-Reflux Surgery
Dr. Portenier highlighted the challenge of treating bariatric patients with GERD, noting that Duke has introduced Stretta to treat obese patients with chronic GERD, especially those after Sleeve Gastrectomy. "This is an area where Stretta makes a lot of sense. These patients are generally unwilling to have their sleeve converted to a Gastric Bypass just to fix their GERD," Portenier said. "With Stretta they avoid additional surgery. In the outstanding results we are seeing at Duke, most Stretta patients see complete or partial resolution of symptoms and are able to get off PPIs." "Stretta is a very low risk endoscopic procedure for these patients," he added.
Discussing refractory GERD sufferers, Dr. Triadafilopoulos explained that these patients experience reflux despite PPI therapy. According to Dr. Triadafilopoulos, there is a large gap between those who don't adequately respond to PPIs and those who choose anti-reflux surgery. "Stretta spans this gap with an outpatient, endoscopic option that has been proven effective and safe for up to 10 years." He presented the case of a refractory GERD patient who underwent Stretta. "The patient experienced heartburn, chest pain and regurgitation despite diet changes and PPI therapy. Testing showed abnormal esophageal acid exposure despite twice daily PPI. Six-months after Stretta, the patient is asymptomatic except for occasional gastric discomfort after meals, is off PPIs, uses occasional antacids, and has a normal pH study."
Dr. Mashimo reviewed his experience with Stretta in laryngopharyngeal reflux (LPR), a condition with symptoms such as chronic cough, hoarseness, asthma and chest pain, often presenting without heartburn. Also called atypical or silent reflux, LPR is caused by a backflow of gastric contents into the pharynx. "Often, LPR patients don't respond well to PPIs and only about half improve after anti-reflux surgery." Mashimo elaborated with a patient example. "The patient had globus sensation and chronic cough, with non-seasonal asthma not responsive to medications. One month after Stretta, she experienced a marked improvement, and one year later the grateful patient had nearly complete resolution of symptoms, and was off PPIs."
Dr. Noar discussed the Stretta option for GERD after anti-reflux surgery (Nissen fundoplication), explaining that 10 years after a Nissen, studies show recurring GERD in up to 42 percent of patients. Reviewing failed Nissen patients from the Stretta 10-year study he noted, "A decade later, 64 percent of these patients were still off daily PPIs." He added, "Stretta treats the internal lower esophageal sphincter without altering the anatomy, important for those with prior surgery, and the only non-surgical option for this type of patient."
"These topics represent unmet needs in GERD treatment where Stretta may be an option to effectively treat chronic sufferers," Dr. Fass added.