Hot needles in my throat eased my heartburn
00:19 GMT, 16 October 2012
00:19 GMT, 16 October 2012
Around 12 million Britons will suffer from acid reflux at some point — and long term it can lead to ulcers and cancer.
Retired investment banker Jeff Sanford, 55, who lives with his wife Ikuyo in Sevenoaks, Kent, underwent a new non-invasive treatment for the problem.
'About ten years ago I started to get heartburn and often a queasy feeling with it,' said Jeff Sanford
My general health has always been fine, but about ten years ago I started to get heartburn and often a queasy feeling with it.
This would happen about twice a week and last for several hours at a time.
Gaviscon tablets helped, but even so I’d still get bouts of heartburn.
Stress seemed to bring it on — my job was pretty demanding.
After putting up with it for a couple of months, I went to see my GP, who diagnosed gastro-oesophageal reflux disease (GORD), or acid reflux.
He explained there’s a valve made of muscle between the stomach and gullet that’s supposed to stop stomach acid rising.
But for some reason in certain people this doesn’t work efficiently.
The doctor said reflux can run in families, and being overweight is also a trigger, but that stress was probably a big part of the cause for me — I’m 12st and 5ft 8in, so like most people my age I could stand to lose a few pounds, but I was not obese.
I was prescribed omeprazole to take daily (possibly for the rest of my life) which reduces the amount of acid your stomach produces.
I was also advised to cut down on possible dietary triggers such as coffee and spicy foods and to ensure I ate slowly.
My GP also sent me for an endoscopy — where they put a tube with a camera on the end down your throat.
They wanted to check for Barrett’s oesophagus, which you can get if you’ve had acid reflux for a while. The acid causes the cells in the gullet (the oesophagus) to change.
And if this isn’t treated, it can lead to oesophageal cancer.
Thankfully there were no signs of it.
However, worryingly, another endoscopy two years ago found evidence of very slight Barrett’s oesophagus. I was advised to have checks every two years to make sure it did not progress.
Another endoscopy in July this year showed the Barrett’s seemed to have gone.
'Since having the procedure I have been feeling fine,' said Jeff
Even so, I decided to seek an alternative to just taking pills — these only mask symptoms and don’t tackle the cause.
I’d also read that some heartburn medications can cause side-effects and that long-term use can lead to osteoporosis.
I considered surgery where the upper part of the stomach is sewn around the oesophagus, to prevent acid leaking upwards. But I didn’t really like the idea of being cut in any way.
I did some research online and came across Dr Chris Fraser, who was doing a new operation called the Stretta procedure.
Basically, they put a tube down your throat and fire radiofrequency waves at the faulty valve — this heats up the tissue, creating scar tissue, which makes it thicker.
The muscle also tightens, meaning it can keep acid in the stomach like it should.
Dr Fraser said most patients could either come off their medication completely or dramatically reduce it.
I thought it sounded good, and in September I had the procedure privately — it cost around £7,000 all in — under general anaesthetic.
It took about an hour and when I came to I felt fine. I was allowed home a couple of hours later.
I had to stick to a soft diet — no foods that might stick in my oesophagus — for a week.
Since having the procedure I have been feeling fine.
I’m looking forward to not having to continually take medicine on a daily basis.
Dr Chris Fraser is consultant gastroenterologist at St Mark’s Hospital, Harrow, and honorary senior lecturer at Imperial College School of Medicine, London. He says:
GORD can affect people of all ages and the incidence is increasing, especially in the under-50s, probably due in part to weight gain.
A family history of reflux, diet, pregnancy, smoking, stress, alcohol consumption, hiatus hernia and certain types of medication are also factors.
Normally when we swallow, a valve between the oesophagus and the stomach — the lower oesophageal sphincter — opens to allow fluid and food to pass into the stomach.
The valve then closes to prevent these flowing back up the oesophagus (refluxing).
In GORD, this valve is weakened, allowing the acid to reflux into the oesophagus, which is not designed to handle acid, so resulting in burning of the tissues there.
GORD can affect people of all ages and the incidence is increasing
The main symptoms are heartburn, chest discomfort, regurgitation, coughing, nausea, wheezing and a hoarse voice. It can cause ulceration and bleeding in the oesophagus.
And one in ten with chronic acid reflux get Barrett’s oesophagus, which takes five to ten years to develop.
Here, the cells that line the lower end of the oesophagus are altered by the digestive acid. As Barrett’s oesophagus does not usually cause any symptoms itself, it is often not picked up until people go to their doctor with reflux symptoms and are referred for an endoscopy.
The condition is important, as it can prompt the development of oesophageal cancer. The incidence of this has risen six-fold since the Seventies — it’s now Britain’s fifth biggest cause of cancer death.
For most sufferers of acid reflux, symptoms are improved with lifestyle changes, such as smaller meals, avoiding caffeine, alcohol, chocolate and spicy foods, stopping smoking, and taking medicines such as Rennie that are alkaline and reduce the acid content, or proton-pump inhibitors (PPIs) — drugs that cut acid production.
But symptoms can still occur, and recently there have been concerns about potential adverse effects relating to long-term use of PPIs, such as the raised risk of C.difficile (stomach acid acts like a disinfectant).
When the changes to lifestyle and medication don’t help, patients may consider surgery. The traditional operation is fundoplication — using a portion of the stomach wall to wrap around the lower part of the oesophagus.
Usually carried out by keyhole surgery, it is effective but invasive, takes time to recover from, and has a risk of complications such as difficulty swallowing, belching and bloating.
Stretta doesn’t involve making any cuts or changing the shape of the stomach.
It was introduced in 2000 and studies have shown significant improvement in heartburn symptoms, with more than 85 per cent of patients medication-free after four years.
Ten-year data indicate these benefits are sustained over the long term.
A flexible catheter (or tube) is passed through the mouth, into the oesophagus and positioned at the lower oesophageal sphincter.
At the end of the catheter is an inflatable balloon with four small ‘needle’ electrodes.
By inflating the balloon using handles at the other end of the catheter, we insert the needles into the muscle of the sphincter.
We then deliver radiofrequency energy, rotating the balloon and repeating the process at several points.
Heating the tissue of the sphincter causes scar tissue to form, so the valve becomes thicker. The sphincter also contracts as it heals. This means it starts working effectively again.
After the procedure a small percentage of patients will experience chest discomfort, bloating and increased gassiness, but none of these last for more than a few days.
Patients are usually weaned off their heartburn medication over four to eight weeks.
The Stretta procedure costs about £7,000. It is done privately in three centres in the UK, but it is being reviewed by NICE, so could be available on the NHS soon.