Dr. Erik Wilson recognized the futility in telling his patients to resume their normal, everyday activities after he'd just inserted a catheter through their noses and down their throats to monitor acid reflux.

As if having heartburn wasn't bad enough, there was now a tube dangling from a nostril. Unattractive, to say the least, it was also uncomfortable and not always the most reliable way to test for Gastro-esophageal Reflux Disease (GERD). This condition, which affects more than 21 million Americans, arises when stomach acid backflows into the esophagus and throat, usually from a faulty lower esophageal sphincter.

Wilson admits it is unrealistic to expect a patient to "go about his business" when all he wants to do is go home and hide for the next 24 hours.

Now, thanks to a new monitoring system-one that we'd expect more from The Jetson's doctor-there is no tube, no embarrassment and no reason patients shouldn't follow orders.

Wilson, assistant professor of surgery at The University of Texas Medical School at Houston, has been offering the Bravo pH monitoring system for a year.

Big Bravo! For a Tiny Test

"This test is the only way to prove definitively whether a patient has acid reflux or if their symptoms are caused by something else," Wilson says. "You don't have to torture patients with a tube. The Bravo system is painless. It collects more data, and we get better results."

The tube in the nostril is replaced with a tiny, high-tech capsule that attaches to the lining of the esophagus. Wilson says most of his patients report that they can't feel the monitoring device at all. Others describe the capsule as feeling like a tiny piece of food lodged in the back of their throats. Otherwise, they say, it is nuisance-free.

The capsule, which is positioned during endoscopy, collects information on the frequency and amount of acid that is refluxing into the esophagus. During the 48-hour monitoring period, it transmits the data to a pager-like receiver. Patients can wear the receiver on their belts like a pager, but they don't have to be attached at the hip to it. As long as the capsule and receiver are within nine feet of each other, the receiver can capture all the information the doctor needs to make an accurate diagnosis. With the receiver nearby, patients can even shower and sleep without interrupting the test.

While the system is getting the inside information, Wilson asks patients to keep a diary of mealtimes and reflux symptoms. He also has them document when they are reclining or lying down.

At the end of the test, patients return the receiver to Wilson. There is no need to remove or recover the capsule. It naturally dislodges from the esophagus and passes through the body. Wilson uploads the information on his computer, analyzes it and provides a diagnosis and course of treatment.

Mild heartburn may be managed with over-the-counter antacids or prescriptions for more frequent, fiery symptoms.

New Fix for a Leaky Valve

Chronic, severe reflux, if left untreated, could eventually lead to cancer of the esophagus. To fix the root of the problem - a defective lower esophageal sphincter - Wilson offers a minimally-invasive surgical solution. The Nissen fundoplication procedure repairs the valve at the end of the esophagus so that acid can no longer creep back up from the stomach. Similar to putting a hotdog in a bun, surgeons take the most upper portion of the stomach and wrap it around the esophagus to reinforce the valve.

The surgery is done through five tiny incisions in the abdomen. It usually takes about an hour, and patients often go home from the hospital the next day.

Wilson says he recommends the acid reflux monitoring test to almost all patients who are considering surgery to permanently stop their chronic heartburn and reflux. Ninety-five percent of patients are candidates for the Bravo pH monitoring system, but Wilson warns that it isn't for everyone. Patients with pacemakers, implantable defibrillators or neurostimulators cannot use the Bravo system. Patients with severe esophagitis or certain bleeding disorders also are not candidates.

Ernest Freeman, a long-time heartburn sufferer, says if the Bravo system wasn't available, he never would have had the test. As an attorney, he didn't want to go to court with a tube hanging out of his nose.

With the capsule and receiver, Freeman says, he truly was able to continue his normal activities. The test revealed severe reflux, and he plans to have the Nissen procedure to correct the problem.

"In recent years we have greatly advanced the treatment of reflux to the point where medical and surgical care of the disease is not only successful but also very safe and easy on the patient," Wilson says. "This new test contributes to this success by allowing us to diagnose reflux with the same safety and ease for the patient."

Last Updated: 5-10-2005

 

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