TIF, an incisionless process, is replacing laparoscopic and other anti-reflux surgeries.

July 23, 2015

You know the routine all too well —you eat a great meal but now you’re paying the price—you experience a burning sensation in your chest. Or, you have a bitter taste that seems to come from the back of your throat. These are just some of the common symptoms of acid reflux—where stomach fluids wash up from your stomach into the esophagus and sometimes into your mouth. When acid reflux becomes chronic, it is not only uncomfortable, but eventually can do damage to the esophagus. As many as 23 million Americans suffer from a severe form of chronic acid reflux known as Gastroesophageal Reflux Disease or GERD for short.

For Geoffrey Davies, his troubles began when he was having sharp chest pains. “I actually didn’t realize I had acid reflux,” says Davies. It was only after he was examined that Davies found out that in addition to acid reflux, he had Barrett’s Esophagus, a serious disease that could lead to esophagus cancer. It occurs when the normal lining of the esophagus (the part of the body that carries food from the mouth to the stomach) transforms into tissue that resembles the lining of the intestines. “I was immediately put on a strict diet. I cut back on all acidic foods and reduced quantities,” remembers Davies.

Davies was a prime candidate for a procedure called Transoral Incisionless Fundoplication (TIF), which is a breakthrough remedy for GERD. While relatively new in the United States, TIF procedures have been commonplace in Europe for 10 years.

“Anybody who truly has gastro reflux and wants to get off medication or is tired of the chronic burning feeling, cough and hoarseness that comes with GERD, TIF can help,” says Dr. Gilbert Simoni, an interventiona gastroenterologist (and natural orifice surgeon) with Advanced GI in Thousand Oaks. “Medications are available such as proton pump inhibitors (PPIs) to help reduce the acids, but there’s a reason we have acids in our stomach. They release important minerals from the food we eat including iron, magnesium and calcium. It’s the reflux that’s the problem, not the acidity in our stomachs.”

Acid reflux is caused when the valve that keeps the acids in the stomach stops working properly.

The TIF procedure involves running a device down the esophagus through the mouth. A small video camera is placed in the center of the device providing a clear view of the damaged valve. A gastroenterologist then uses small pieces of tissue to repair the valve so it opens and closes correctly and acids in the stomach do not come back up into the esophagus. TIF is an incisionless process that is replacing laparoscopic and other anti-reflux surgeries.

To prepare for his TIF procedure, Davies fasted the night before. “Nothing other than that,” says Davies. “It was easy.” The surgery took less than an hour to complete.

“Most patients may have a little sore throat afterwards,” says Dr. Simoni. He recommends not driving for two days and wait three or four days before returning to work. Patients are initially on a liquid diet and gradually over the next six weeks, they increase their solid food intake until they are back to a normal diet. “We need to give the area time to heal,” he says.

In recent studies, patients reported 80 percent improvement in quality of life and reduction or elimination of heartburn symptoms. The success rate for the procedure has prompted an increase in demand.

Dr. Simoni was the first gastroenterologist in the United States to be trained to perform the TIF procedure. He now trains other doctors. “Before TIF, the only option was complicated surgery that would take three to five hours and up to five days in the hospital,” explains Dr. Simoni. “We would have to make an incision in the abdomen.”

Drugs such as PPIs make the patient feel better, but after a while, they can lose their effectiveness. When stomach acid is reduced using PPIs over the long-term (one year or more), side effects can include the development of bacteria in the colon and osteoporosis-related bone fractures since calcium absorption is suppressed.

Dr. Simoni cautions, “TIF is not a magic bullet that eliminates reflux. Almost everyone has some sort of reflux. In severe cases, however, TIF should diminish chronic symptoms so patients are no longer on drugs and can lead normal lives.”

For Davies, the differences are life changing. “I’m now able to eat anything I want—spicy food, red wine. I’m no longer taking acid reflux medication. I would say to anyone who has acid reflux symptoms to go get checked out. It’s a minimally invasive cure that has done wonders.”