GERD: Advances in Treatment and Prevention

By Elesa Swirgsdin
Friday, September 10, 2021
Specialty: 

Recent trials and studies have led to promising insights and new options for the management and treatment of GERD for some patients.

Gastroesophageal reflux disease (GERD) affects approximately 30% of the population in the United States. In recent years, researchers have increasingly focused on improving treatments for GERD, as the condition can have a negative effect on patients’ overall quality of life and increase the risk of serious complications such as severe chest pain, esophageal stricture, Barrett’s esophagus and esophageal cancer.

Despite this urgency, physicians have faced hurdles in finding the most effective treatments for their patients. This is due in part to the wide range of symptoms that can sometimes make it difficult to diagnose and even more difficult to successfully treat. Additionally, some surgical procedures, while effective, can trigger side effects that continue to hinder patients’ quality of life. However, some new therapies display encouraging results.

Diet and Lifestyle Changes Can Control Women’s Symptoms

A recent Nurses’ Health Study II revealed that five specific lifestyle factors can prevent or drastically reduce GERD symptoms and eliminate the need for medication in some female patients. The results of the study, published as a research letter in JAMA Internal Medicine in January 2021, confirm that lifestyle and eating habits have a significant impact on the disease.

“GERD is a very common problem among women and can have a profoundly negative impact on quality of life,” says senior author Andrew T. Chan, MD, Professor of Medicine and gastroenterologist at Massachusetts General Hospital and Harvard Medical School. “Although there are effective medications available for treatment, many women are worried about taking them long-term. This motivated us to determine if we could identify a role for modifying diet and lifestyle to prevent reflux symptoms.”

The Nurses’ Health Study II is an ongoing, nationwide study that began in 1989, with participants returning detailed biennial questionnaires on various health issues. For this study, nearly 43,000 women answered questions on GERD symptoms and lifestyle factors every four years, from 2005 through 2017. The analysis concluded that following an anti-reflux lifestyle can reduce the incidence of GERD symptoms by 40%. This lifestyle includes:

  • Drinking no more than two cups of coffee, tea or soda per day
  • Eating a healthy diet
  • Maintaining a healthy body weight, defined as a BMI of 18.5 to less than 25.0
  • Not smoking
  • Staying physically active, with at least 30 minutes of moderate to vigorous exercise per day

“The diet associated with less reflux symptoms is generally in keeping with what we consider to be a healthy diet — low in concentrated sweets, red meat and refined grains,” Dr. Chan says.

Women who regularly take medication for GERD, including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), also reported a reduced occurrence of symptoms.

New Endoscopic Device Promising for PPI-Dependent Patients

Researchers in India found that the placement of an endoscopic full-thickness fundoplication device (EFTP) called the GERDx in patients on long-term PPI therapy can replace the need for a more invasive surgical procedure.

“Our study found endoscopic full-thickness fundoplication was safe and significantly improved GERD-related quality of life and severity of reflux symptoms at short and long terms, compared with a sham procedure,” according to Rakesh Kalapala, MD, Director of Endoscopy at the Center for Obesity and Metabolic Therapy, part of the Asian Institute of Gastroenterology in Hyderabad, and colleagues in an article in Gut.

EFTP utilizes transmural sutures, which are applied at the gastroesophageal junction to help restructure the gastric cardia and strengthen the valvular mechanism. Other EFTP devices are available, but the GERDx device has distinct advantages, according to Dr. Kalapala and colleagues.

“Compared with other EFTP devices, GERDx appears to be simpler, less cumbersome with a shorter procedure time and safer,” note the study authors.

The small randomized controlled trial revealed that the GERDx device improved health-related quality of life by 67.5% or more at three months for patients in the EFTP group, as compared to only 2.9% in the sham or control group. By the six-month marker, this fraction climbed to 81.4% and 8.0%, respectively, and at 12 months, to 92.3% and 9.1%.

Researchers also saw significant improvements in overall GERD symptoms for EFTP patients. At 12 months, 62.8% of these patients were able to discontinue PPIs, as compared to 11.4% of sham patients. However, the GERDx device led to only a slight improvement in esophageal acid exposure.

“Improvement in GERD-HRQL [Health-Related Quality of Life, a patient-reported outcomes scale] may be a more relevant and patient-centric goal as compared with normalization of esophageal acid exposure, which is infrequent with the currently available devices,” the authors write.

Dr. Kalapala and colleagues also note that patient selection is very important. “Preferred cohort of patients who would benefit from EFTP includes those with PPI dependence, abnormal acid or non-acid reflux and small hiatus hernia,” the authors write.

While larger trials are needed, the GERDx device is a promising alternative therapy for patients who are opposed to surgery and who wish to discontinue PPIs.