Delivery of radiofrequency energy to the lower oesophageal sphincter and gastric cardia inhibits transient lower oesophageal sphincter relaxations and gastro-oesophageal reflux in patients with reflux disease

• Published in: Gut Vol. 52; no. 4; pp. 479 - 485
• Main Authors: Tam, W C E, Schoeman, M N, Zhang, Q, Dent, J, Rigda, R, Utley, D, Holloway, R H
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.04.2003; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; Copyright 2003 by Gut
• Subjects: Acids; Adult; Aged; Antacids - administration & dosage; Biological and medical sciences; Cardia - surgery; Care and treatment; Catheter Ablation - methods; Diseases of the digestive system; Drug Administration Schedule; Drug therapy; Endoscopy; Esophagogastric Junction - physiopathology; Esophagogastric Junction - surgery; Female; Follow-Up Studies; gastro-oesophageal reflux disease; Gastroesophageal reflux; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - physiopathology; Gastroesophageal Reflux - surgery; GORD; Humans; Hydrogen-Ion Concentration; Long term; LOS; lower oesophageal sphincter; Male; Medical sciences; Middle Aged; Monitoring, Ambulatory; Mortality; Muscle Relaxation; oesophageal motility; oesophageal pH monitoring; Oesophagus; Postprandial Period; QoL; quality of life; radiofrequency energy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); RFe; Studies; Surgery; TLOSRs; transient LOS relaxations; Treatment Outcome; Tropical medicine; Australia; Oceania; Los Angeles California; Human; Gastroesophageal reflux; Relaxation; Treatment; Esophageal sphincter; Esophageal disease; Instrumentation therapy; Cardia; Digestive diseases; Radiofrequency; Statistical study; Biological activity
• DOI: 10.1136/gut.52.4.479
• ISSN: 0017-5749

Background and aims: Radiofrequency energy (RFe) treatment to the lower oesophageal sphincter (LOS) and gastric cardia is a new luminally delivered therapy proposed as an alternative treatment for gastro-oesophageal reflux disease (GORD). However, it is unclear how RFe achieves its antireflux effect. This study investigated the effects of RFe on mechanisms of spontaneous reflux in patients with GORD. Methods: Twenty patients with GORD underwent endoscopy, symptom evaluation, and combined postprandial oesophageal manometry and pH monitoring before and six months after RFe, and 24 hour ambulatory pH monitoring before and at six and 12 months after treatment. Results: RFe reduced the rate of postprandial transient LOS relaxations from 6.8 (5.7–8.1) (median (interquartile range) per hour to 5.2 (4.2–5.8) per hour (p<0.01), and increased mean basal LOS pressure from 5.2 (SEM 0.3) mm Hg to 8.0 (SEM 0.4) mm Hg (p<0.01). The number of reflux events was reduced from 10 (2–15.3)/3 hours to 5 (3.5–8.5)/3 hours (p<0.05) and there was an associated significant reduction in acid exposure time from 5.4% (0.4–14.7) to 3.9% (0.4–6.6) (p<0.05). RFe significantly reduced ambulatory oesophageal acid exposure from 10.6% (7.8–13.0) to 6.8% (3.1–9.1) (p<0.01) at six months and 6.3% (4.7–10.9) (p<0.05) at 12 months. All patients required acid suppressant medication for symptom control before RFe. Six months after treatment, 15 patients (75%) were in symptomatic remission and 13 (65%) at 12 months. Conclusions: RFe has significant effects on LOS function that are associated with improvement in the antireflux barrier. Uncontrolled clinical data also suggest a beneficial effect in the control of reflux symptoms in these patients.