By ROBERT CAHILL
The University of Texas Health Science Center at Houston
If you listen to sports radio programs in Houston, Texas, you have probably heard Lance Zierlein. On the local airwaves for more than a decade, Zierlein is a popular sports commentator who makes the morning commute bearable for many motorists. But, close listeners may have noticed something amiss.
Zierlein seemed to spend a lot of air time clearing his throat. That’s because he was. In fact, in some circles, the father of five is known as “the guy who’s always clearing his throat.”
Zierlein suffered from a disorder called Gastroesophageal Reflux Disease (GERD), which affects about a quarter of the estimated 60 million Americans with acid reflux each month. Some people with GERD have likened the sensation in their throats to battery acid burn.
Thanks to an innovative procedure performed by Erik Wilson, MD, of The University of Texas Health Science Center at Houston (UTHealth) Medical School, Zierlein should go a lot longer between harrumphs during his SportsTalk 790 AM morning show. The procedure did not involve any surgical incisions and Zierlein was in and out of Memorial Hermann-Texas Medical Center in a couple of days.
“It was a big distraction,” says Zierlein about GERD, who was concerned that his voice would break up while he was on the air.
GERD also affected his home life. “I had to watch what I ate. I had to avoid eating much after 5 pm or so at night,” says Zierlein, who also writes a sports blog.
TIF: fixing a leaky valve
Reflux is the abnormal regurgitation of stomach and intestinal contents into the esophagus, which is the muscular tube connecting the mouth and stomach.
The procedure is designed to significantly improve or permanently eliminate symptoms by addressing the underlying cause of reflux: reducing the hiatal hernia, if one exists, and reconstructing the valve between the esophagus and stomach. It is called a Transoral Incisionless Fundoplication (TIF).
The repairs are all made with a device and endoscope that are inserted through the mouth. Wilson says the procedure is recommended for patients with small hiatal hernias, a condition where a portion of the stomach slips out of place and into the chest cavity.
“I hope now to be able to enjoy a glass of red wine at 9 pm and to do an hour-long show by myself,” says Zierlein, who can be heard weekday mornings.
Like Zierlein, 19-year-old Rourke Pollard had GERD. “I had a burning sensation in my chest. It really made it hard to get sleep,” says Pollard, who is a sophomore at Texas A&M University in College Station, and hopes to become a physician. “As a result, I was a tired a lot of the time.”
Pollard had the procedure and says the pain is now gone. “There have been no downsides or side effects. Theoretically, the repair should be good forever,” says Pollard, who used to have to take prescription acid blockers and antacids to stop the pain.
Wilson says, “Acid reflux can limit patients’ lifestyles significantly. Patients may suffer for years and years without any relief. They sleep in recliners, because if they lie down, content from their stomachs comes up. They always have a bad taste in the back of their throats. This incisionless procedure could be the solution that puts a stop to these symptoms.”
Texas A & M University sophomore Rourke Pollard can rest easy at night because he does not have to worry about reflux keeping him up.
Symptom control is the key
With or without surgery, it is important to control symptoms. “Reflux is linked to adult-onset asthma, and in severe cases, the acid can cause changes in the lining of the esophagus, which can lead to cancer,” says Wilson, who is the director of Minimally Invasive Surgeons of Texas at UTHealth and on the medical staff at Memorial Hermann-TMC.
Medications, both prescription and over-the-counter, can be effective, but Wilson cautions that the drugs only stop acid from forming in the stomach. They don’t stop stomach content from rising to the back of the throat. They also do not fix the root of the problem, which is a defective valve-like structure — the lower esophageal sphincter.
This valve at the end of the esophagus is designed to let food into the stomach and keep it there. If the valve is compromised, stomach acid and partially digested food can creep back up the esophagus.
The surgical option
A surgical solution is not for everyone, Wilson says, but if chronic heartburn is severe enough to affect a patient’s life and the patient doesn’t want to take daily medication to control symptoms, he or she may want to discuss that option with a physician.
In addition to the TIF procedure, Wilson offers a procedure called the Nissen fundoplication to alleviate chronic heartburn. 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 Nissen surgery is done through five tiny incisions in the abdomen. It usually takes about an hour, and patients usually go home the next day. The EsophyX procedure also takes about an hour.
As with any surgery, there are risks, such as injury to the spleen, stomach or esophagus. To reduce such risks, Wilson, who has performed hundreds of procedures to stop acid reflux, advises that patients choose a surgeon who is highly experienced in this procedure.
After surgery, patients may have difficulty swallowing. Physicians prescribe them a liquid diet for the first 2-3 weeks, and if this condition continues, the surgeon can put a scope down the patient’s throat to gently dilate it.
Repairing the valve keeps acid and food down. It also may keep gas down, making it difficult for patients to burp. They may experience gas bloat until the body adjusts. “Basically you are creating a more normal body physiology. The body has been used to gulping down air and refluxing for years,” Wilson says. “It can take a while, maybe even a few months, for the body to acclimate.”
Clinical trial available
Wilson’s team is currently recruiting adults with GERD for a TIF clinical trial. “We are one of a select group of sites in the United States chosen to participate in the study,” Wilson says. “The fundamentals of the procedure have been studied in animals and humans. We’re gathering additional data on outcomes.”
Nationwide, 120 people are being recruited for the multi-center, randomized trial for the treatment of GERD. Two out of three participants will receive the incisionless procedure and a placebo medication. The remainder will get a control procedure and a medication called omeprazole.
Afterward, researchers will compare data to better understand the relative merits, safety and effectiveness of the TIF procedure, which is approved by the Food and Drug Administration.
In the Houston area, Wilson hopes to recruit at least 15 people. Eligible participants will receive multiple follow-up checkups over the course of 12 months. Once the study is over, the procedure will be offered to those who originally received the control procedure. There is no charge for the procedure.
Wilson’s team is looking for people 18 to 80 years old, who have chronic symptoms and have been taking a medication to control symptoms. People interested in enrolling in the study should call Anna Cecilia Tenorio at 713- 486-1350 to determine eligibility. Participants may be asked to complete screening tests that may be covered by insurance.
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