A revolutionary scalpel-free procedure that strengthens weak muscles in the oesophagus could spare millions from chronic heartburn… for good.
The 60-minute operation, which could be available to NHS patients as early as next year, closes gaps between the oesophagus and the stomach – through which the stomach juices flow, causing the burn.
Carried out by putting a tube down the throat with tools attached, it requires no cuts to the body, and therefore leaves no scars.
Experts say it could soon be available across the NHS following trials showing that nearly nine out of ten patients undergoing the method are free from heartburn symptoms – including chest pain and burning in the throat after eating – at least three years later.
Chronic heartburn, known as gastro-oesophageal reflux disease, or GERD, affects one in five Britons.
The 60-minute operation, which could be available to NHS patients as early as next year, closes gaps between the oesophagus and the stomach – through which the stomach juices flow, causing the burn
The symptoms, often triggered by large meals or heavy drinking, occur when stomach acid and other juices travel up the food pipe to the back of the throat, due to a weakness in the muscular ring, or valve, that separates the pipe, or oesophagus, and the stomach.
Left untreated, about 15 per cent of people will go on to develop a condition known as Barrett’s oesophagus, where the lining is damaged by stomach acids – a precursor to cancer.
Lifestyle changes such as losing weight, stopping smoking and cutting out alcohol and fizzy drinks can ease symptoms by reducing levels of acid and alleviating the pressure on the muscle.
But many go on to rely on drugs called proton pump inhibitors, or PPIs, which stop the cells inside the stomach producing too much acid.
While this does provide relief, they can have significant side effects including headaches, diarrhoea and nausea. And in the longer term, because they can affect the absorption of key nutrients such as calcium and Vitamin B12, it is thought they might also contribute to problems with bone density, kidney issues and fatigue.
The standard NHS treatment if the drugs stop working is keyhole surgery, involving several cuts in the abdomen, through which doctors wrap the upper part of the stomach around the bottom of the oesophagus and tighten it, to stop the upward flow of acid.
It involves an overnight stay in hospital and patients must eat pureed food for at least six weeks.
But it can it lead to problems swallowing, bloating, flatulence and burping, and about a third of people still need to use PPIs.
The latest operation, called transoral incisionless fundoplication, or TIF, has already been widely used in the US and causes few side effects, with no incision necessary.
Carried out by putting a tube down the throat with tools attached, it requires no cuts to the body, and therefore leaves no scars. Pictured: Stock image
Under general anaesthetic, it involves going through the mouth with a thin tube holding a camera, known as an endoscope, to allow doctors to see inside the oesophagus, and a surgical stitching tool known as EsophyX.
This device enters via the throat and uses 20 tiny stitches to pin together folds of tissue at the bottom of the oesophagus over the existing valve, making it harder for stomach juices to pass through.
Over time, the body naturally constructs a new layer of tissue bolstering the valve, and making it more effective.
The operation is over within an hour. Patients are home by the end of the day and are advised to eat soft – but not pureed – foods for a couple of weeks.
‘You’re trying to do two things here – improve quality of life by getting rid of debilitating symptoms, and keeping the oesophagus safe for the future,’ says Dr Rehan Haidry, consultant gastroenterologist at University College London Hospital, who performs the operation privately at The London Clinic.
‘There’s no surgical incision, it’s a day-case operation, it doesn’t cause the same problems with gas and swallowing that standard treatment does, and the data shows it’s durable for at least five years.’
An analysis of several small studies has found that about 80 per cent of patients had either completely healed or had improved symptoms following the procedure. Over five years, 78 per cent said they no longer had to use PPIs.
Currently, the procedure is sanctioned for use on the NHS on a trial basis only. But Dr Haidry hopes to bring it to a London NHS hospital in early 2021. He is also ready to train surgeons from Newcastle and Portsmouth.
Frank Gleeson, a 54-year-old hospitality executive from Dublin, had the operation last month after 15 years of being dependent on medication for his acid reflux.
He had developed Barrett’s oesophagus, which meant he needed to have regular cancer screenings.
His symptoms were so bad that he was putting bricks under the head of his bed to prop himself up at night, as lying horizontal often exacerbates acid reflux. ‘I couldn’t keep living like that,’ says the father-of-four.
He saw adverts for the TIF procedure during a business trip to the US and travelled to The London Clinic for the treatment.
He admits there was some discomfort afterwards, and he has been eating soft foods, but says: ‘I’m on a quarter of my original PPI dosage and hopefully I’ll be weaned off it completely in a few weeks. I feel better than I have in ten years.’
The TIF procedure is available at The London Clinic (thelondonclinic.co.uk) at a cost of £12,850.