Electrical stimulation of the esophagus promising treatment for unresolved reflux symptoms

ScienceDaily (Oct. 22, 2012) — Clinical evidence of the safety and effectiveness of electrical stimulation of a muscular valve in the esophagus demonstrates promising results in resolving symptoms of gastroesophageal reflux (GERD) and is being presented at the 77th Annual Scientific Meeting of the American College of Gastroenterology in Las Vegas, NV on October 22.

Three studies examined small numbers of patients who had a device implanted that uses low energy electrical pulses to strengthen a weak or dysfunctional lower esophageal sphincter (LES) which is the underlying cause of GERD or acid reflux. The LES is the ring shaped muscular valve that keeps the acidic contents of the stomach from the esophagus, or food tube.

Two studies by investigators Michael Crowell, Ph.D., FACG of Mayo Clinic Scottsdale and Edy Soffer, MD, FACG of the University of Southern California looked at various endpoints including esophageal acid exposure, improvement in GERD symptoms, and reduction of use of acid-suppressing medications known as proton pump inhibitors. In a study of 25 patients, the investigators found that 77 percent of patients reported either normalization or at least a 50 percent reduction in PPI use. At 12 months after the implant of the device, there was a statistically significant improvement in patients' scores on a scale measuring health-related quality of life for patients with GERD. The authors conclude, "Electrical stimulation of the lower esophageal sphincter is effective for treating patients with GERD over long-term year duration." The authors reported relationships with the Netherlands-based EndoStim BV which manufactures the device.

In a separate and unrelated study, Arjan Bredenoord, MD and colleagues at the University Medical Center Utrecht in Rotterdam, The Netherlands, presented a study at ACG of eleven patients with refractory GERD symptoms with devices implanted in the LES. They found that ten of the eleven patients (91 percent) were able to discontinue PPI medications. Overall, their research revealed a statistically significant improvement in patients' GERD symptoms, as well as a trend in improvement in their esophageal pH.

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The above story is reprinted from materials provided by American College of Gastroenterology (ACG), via Newswise.

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Type 2 diabetes may increase the risk of Barrett's esophagus

ScienceDaily (Oct. 22, 2012) — Patients with Type 2 Diabetes may face an increased risk for Barrett's Esophagus (BE), regardless of other risk factors including smoking, alcohol consumption, obesity and gastroesophageal reflux disease (GERD), according to research unveiled October 22 at the American College of Gastroenterology's (ACG) 77th Annual Scientific meeting in Las Vegas.

The study, "Diabetes Mellitus Increases the Risk of Barrett's Esophagus: Results from A Large Population Based Control Case Study," suggests that, "if you have diabetes, your risk for Barrett's esophagus (BE) may be almost doubled ," said co-investigator, Prasad G. Iyer, M.D., of the Mayo Clinic College of Medicine. He said this risk may be higher in men with diabetes likely because men tend to carry more fat in the abdomen compared to women who tend to carry weight around the hips and thighs.

Type 2 diabetes is the most is the most form of diabetes, with millions of Americans living with the disease. Barrett's esophagus is a condition in which the tissue lining the esophagus is replaced by tissue that is similar to the lining of the intestine. No signs or symptoms are associated with Barrett's esophagus but it is commonly found in people with GERD. About 5 to 10 percent of patients with chronic GERD will develop Barrett's esophagus.

Performing a population-based control study using the United Kingdom's General Practice Research Database (GPRD) (a primary care database containing more than 8 million patients), the researchers identified 14,245 Barrett's esophagus cases and 70,361 controls without Barrett's esophagus. Cases were more likely than controls to have ever smoked and consumed alcohol; and the prevalence of Type 2 diabetes before Barrett's esophagus diagnosis was higher in cases than controls. The mean BMI was also higher in cases than in controls both at baseline and over the study period.

Obesity is associated with an increased risk of Barrett's esophagus and esophageal cancer, but it is "unclear" if this is caused from a mechanical and/or metabolic effects such as hyperinsulinemia, according to investigators, who aimed to determine if there is an epidemiologic link between Type 2 diabetes and Barrett's esophagus after adjusting for known risk factors including obesity, smoking, alcohol use and GERD.

"Interestingly, we found that among the study cohort, if you had diabetes there was a twofold increase in your risk for Barrett's esophagus," explained Dr. Iyer. "When we stratified the results by gender, the association of Type 2 diabetes with Barrett's esophagus was stronger in males compared to females, which may reflect the different fat distributions in men and women."

Dr. Iyer said that while this study is retrospective -- and further prospective studies are needed to better understand the link between Barrett's Esophagus and Type 2 Diabetes -- the results do offer valuable and potentially life-saving insight to patients and health care providers: "if you lose weight your risk for Barrett's esophagus and esophageal cancer may decrease." Dr. Iyer suggested patients who are overweight, particularly if they carry their excess weight in their belly, talk to their physicians about their risk for Barrett's Esophagus and whether they should undergo screening through an upper endoscopy.

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