Heartburn Support - Stretta and PH values

Author

Stretta and PH values

Blocks to Books

2006-10-18, 4:25 pm

Today I read a couple of articles that seemed to imply that Stretta is
possibly not significantly changing the ph values in the esophagus, although
symptoms are being significantly improved. Could this possibly indicate
that the sensitivity to acid reflux or heartburn pain is reduced by the
procedure while possibly not reducing the reflux coming up into the
esophagus? I don't have any pain or heartburn symptoms - just lpr coughing
and mucous symptoms. Stretta was my one hope for a cure because I don't
believe the fundo is an alternative for me due to my lifestyle of high
intraabdominal pressures that could possibly cause it to slip or
fail. -Blocks

Howard McCollister

2006-10-18, 4:25 pm

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:hBuZg.1449$rS.1292@fed1read05...
> Today I read a couple of articles that seemed to imply that Stretta is
> possibly not significantly changing the ph values in the esophagus,
> although symptoms are being significantly improved. Could this possibly
> indicate that the sensitivity to acid reflux or heartburn pain is reduced
> by the procedure while possibly not reducing the reflux coming up into the
> esophagus? I don't have any pain or heartburn symptoms - just lpr
> coughing and mucous symptoms. Stretta was my one hope for a cure because
> I don't believe the fundo is an alternative for me due to my lifestyle of
> high intraabdominal pressures that could possibly cause it to slip or
> fail. -Blocks
>

I haven't seen such articles. What you report is at odds with any
peer-reviewed literature that I've read.

There is a certain percentage of people for whom Stretta won't work
(commonly reported at about 30-40% of GERD patients). If patients are
reporting decreased symptoms in the face of unchanged pH studies, I suspect
placebo effect is at work to a large degree. Endo-Cinch demonstrated the
same phenomenon before it was ultimately abdandoned as being ineffective.

HMc

Blocks to Books

2006-10-18, 4:25 pm

"Howard McCollister" <nospam@nospam.net> wrote in message
news:45367970$0$54881$bb4e3ad8@newscene.com...
>
> "Blocks to Books" <news@blockstobooks.com> wrote in message
> news:hBuZg.1449$rS.1292@fed1read05...
>
>
> I haven't seen such articles. What you report is at odds with any
> peer-reviewed literature that I've read.
>
> There is a certain percentage of people for whom Stretta won't work
> (commonly reported at about 30-40% of GERD patients). If patients are
> reporting decreased symptoms in the face of unchanged pH studies, I
> suspect placebo effect is at work to a large degree. Endo-Cinch
> demonstrated the same phenomenon before it was ultimately abdandoned as
> being ineffective.
>
> HMc

Below are the links to a Medscape article and another journal article that
discusses ph values. The second article requires registration in order to
read it. They both seem to reference the same study where ph values seemed
to be relatively unchanged while symptomatic pain relief was provided. They
seemed to surmise that perhaps the procedure de-sensitized the pain response
in nerves in the esophagus, but were unsure why the relief was occurring but
I could be mistaken.

http://www.medscape.com/viewarticle/457765_26

http://gastroenterology.jwatch.org/...tion/2002/417/4

In the second article the issue of ph values is discussed only in the
comments section. They don't seem to question the safety of the procedure,
but they do comment on the ph value results. It's possible I am not reading
and understanding the study results correctly in both articles. I really
hope I'm mistaken and mis-reading the results. -Blocks

Blocks to Books

2006-10-18, 9:25 pm

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:4mvZg.1452$rS.1247@fed1read05...
>
> "Howard McCollister" <nospam@nospam.net> wrote in message
> news:45367970$0$54881$bb4e3ad8@newscene.com...
>
> Below are the links to a Medscape article and another journal article that
> discusses ph values. The second article requires registration in order to
> read it. They both seem to reference the same study where ph values
> seemed to be relatively unchanged while symptomatic pain relief was
> provided. They seemed to surmise that perhaps the procedure de-sensitized
> the pain response in nerves in the esophagus, but were unsure why the
> relief was occurring but I could be mistaken.
>
> http://www.medscape.com/viewarticle/457765_26
>
> http://gastroenterology.jwatch.org/...tion/2002/417/4
>
> In the second article the issue of ph values is discussed only in the
> comments section. They don't seem to question the safety of the
> procedure, but they do comment on the ph value results. It's possible I am
> not reading and understanding the study results correctly in both
> articles. I really hope I'm mistaken and mis-reading the results. -Blocks

I couldn't get the first link to work. I required registration from that
link whereas it didn't require registration when I got it from a search I
did. I got to the link originally by doing a google web search using the
words stretta complications. It is listed among the first ten or so and it
can be read from that search link without registration. The Medscape article
is titled and authored by:
New Evidence in the Treatment of Acid-Related Disorders
Nimish B. Vakil, MD

An Overview of the Stretta Technique
I am hopeful you will be able to skim read at least one of the articles to
tell me what you think and if I mis-read the conclusions. If you can't
access either one of them, you might know of a better way for me to get it
to you or a way to copy it so it can be read on the newsgroup, etc. I'm not
extremely computer literate but I am fairly good at following
instructions. -Blocks

Howard McCollister

2006-10-18, 9:25 pm

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:R1xZg.1453$rS.892@fed1read05...
>
> I couldn't get the first link to work. I required registration from that
> link whereas it didn't require registration when I got it from a search I
> did. I got to the link originally by doing a google web search using the
> words stretta complications. It is listed among the first ten or so and
> it can be read from that search link without registration. The Medscape
> article is titled and authored by:
> New Evidence in the Treatment of Acid-Related Disorders
> Nimish B. Vakil, MD
>
> An Overview of the Stretta Technique
> I am hopeful you will be able to skim read at least one of the articles to
> tell me what you think and if I mis-read the conclusions. If you can't
> access either one of them, you might know of a better way for me to get it
> to you or a way to copy it so it can be read on the newsgroup, etc. I'm
> not extremely computer literate but I am fairly good at following
> instructions. -Blocks
>
>

An interesting data presentation, but the methodology isn't delineated.
Anyway, the largest study was Triadofolous' followup to his own initial 2001
study and I view that as consistent, showing a decrease in acid reduction.
Additionally, as I've mentioned, I believe that patient selection relative
to resting LES pressure is an important component in achieving reduction in
acid exposure with the technique and in none of those studies do I perceive
any attempt at patient selection other than hiatus hernia greater than 2 cm.

That said, I do think it's reasonable to question the effectiveness of the
Stretta procedure. It certainly isn't the best anti-reflux treatment out
there. Fundoplication is...

HMc

Blocks to Books

2006-10-19, 4:23 pm

"Howard McCollister" <nospam@nospam.net> wrote in message
news:4536e13d$0$2943$bb4e3ad8@newscene.com...
>
> "Blocks to Books" <news@blockstobooks.com> wrote in message
> news:R1xZg.1453$rS.892@fed1read05...
>
> An interesting data presentation, but the methodology isn't delineated.
> Anyway, the largest study was Triadofolous' followup to his own initial
> 2001 study and I view that as consistent, showing a decrease in acid
> reduction. Additionally, as I've mentioned, I believe that patient
> selection relative to resting LES pressure is an important component in
> achieving reduction in acid exposure with the technique and in none of
> those studies do I perceive any attempt at patient selection other than
> hiatus hernia greater than 2 cm.
>
> That said, I do think it's reasonable to question the effectiveness of the
> Stretta procedure. It certainly isn't the best anti-reflux treatment out
> there. Fundoplication is...
>
> HMc

Thank you very much for your input. I found a stretta physician on who is
on my insurance plan using a link I found on the Curon site - although he is
not on their site as a stretta physician. The physician's office said the
pre-stretta testing "may" be reimbursed by my insurance and my insurance
company says the surgery won't. I didn't want to even waste my time and my
money to go for the consultation appt. if the articles are accurate. I'm
not a heartburn sufferer and, if it only provides heartburn pain relief with
little change in PH, then it wouldn't help me at all - other than to help me
out of thousands of dollars of my money.

I see the Stretta physician tomorrow. His office told me they do not
normally test for LES resting pressure - which I believe might be a big
issue for me because of the reflux patterns I see in myself. They will do
an endoscopic exam of the esophagus, which will show if I have a hernia. I
don't know if it will measure LES resting pressure or not. I'm going to ask
the doctor about a test for LES resting pressure. I will also ask if his
office will be willing to share the actual test results with me after each
test. Some doctors don't like to do that but it will be critical for me to
know the exact test results in order to make a decision if I want to go
through with the procedure or not.

Again, thank you so much for taking the time to read those articles. It
really freaked me out reading them and I felt I needed professional input
other than from the surgeon who might be doing the procedure. -Blocks

Howard McCollister

2006-10-19, 4:23 pm

"Blocks to Books" <news@blockstobooks.com> wrote in message
news:EvMZg.1480$rS.637@fed1read05...
>
>
> Thank you very much for your input. I found a stretta physician on who is
> on my insurance plan using a link I found on the Curon site - although he
> is not on their site as a stretta physician. The physician's office said
> the pre-stretta testing "may" be reimbursed by my insurance and my
> insurance company says the surgery won't. I didn't want to even waste my
> time and my money to go for the consultation appt. if the articles are
> accurate. I'm not a heartburn sufferer and, if it only provides heartburn
> pain relief with little change in PH, then it wouldn't help me at all -
> other than to help me out of thousands of dollars of my money.
>
> I see the Stretta physician tomorrow. His office told me they do not
> normally test for LES resting pressure - which I believe might be a big
> issue for me because of the reflux patterns I see in myself. They will do
> an endoscopic exam of the esophagus, which will show if I have a hernia.
> I don't know if it will measure LES resting pressure or not. I'm going to
> ask the doctor about a test for LES resting pressure. I will also ask if
> his office will be willing to share the actual test results with me after
> each test. Some doctors don't like to do that but it will be critical for
> me to know the exact test results in order to make a decision if I want to
> go through with the procedure or not.
>
> Again, thank you so much for taking the time to read those articles. It
> really freaked me out reading them and I felt I needed professional input
> other than from the surgeon who might be doing the procedure. -Blocks
>

You have an absolute right to those test results, or anything else contained
in your medical chart. They may charge you to copy them, but if they deny
you those results, or if they take an inordinately long time to supply you
with them, then you need to tell them you'll be filing a complaint with your
state's board of medical practice. I sincerely doubt they'll give you any
grief over it. There's absolutely no reason to keep a patient's medical
records secret from them, it's morally wrong, and it's illegal besides.

There is no "pre-Stretta" testing...there is only esophageal diagnostic
testing and it's the same for any anti-reflux procedure. EGD, ambulatory pH
testing and esophageal manometry (especially LES testing), are absolutely,
100% mandatory before ANY anti-reflux surgery. LES resting pressure is a
fundamental part of esophageal manometry. In fact, doing a Stretta without
manometry, without knowing the performance of the LES is most definitely a
deviation from the standard of care and a huge liability risk for any doctor
dumb enough to do a Stretta without one.

HMc

Blocks to Books

2006-10-20, 4:24 pm

"Howard McCollister" <nospam@nospam.net> wrote in message
news:453797f7$0$54863$bb4e3ad8@newscene.com...
>
> "Blocks to Books" <news@blockstobooks.com> wrote in message
> news:EvMZg.1480$rS.637@fed1read05...
>
> You have an absolute right to those test results, or anything else
> contained in your medical chart. They may charge you to copy them, but if
> they deny you those results, or if they take an inordinately long time to
> supply you with them, then you need to tell them you'll be filing a
> complaint with your state's board of medical practice. I sincerely doubt
> they'll give you any grief over it. There's absolutely no reason to keep a
> patient's medical records secret from them, it's morally wrong, and it's
> illegal besides.
>
> There is no "pre-Stretta" testing...there is only esophageal diagnostic
> testing and it's the same for any anti-reflux procedure. EGD, ambulatory
> pH testing and esophageal manometry (especially LES testing), are
> absolutely, 100% mandatory before ANY anti-reflux surgery. LES resting
> pressure is a fundamental part of esophageal manometry. In fact, doing a
> Stretta without manometry, without knowing the performance of the LES is
> most definitely a deviation from the standard of care and a huge liability
> risk for any doctor dumb enough to do a Stretta without one.
>
> HMc

I had my first consultation with the Stretta surgeon today. He seemed
competent and communicative and not put off by an informed patient. I was
relieved to learn that his office was incorrect about them not doing
manometry testing before the Stretta. They always do a manometry test if
the person isn't eliminated during the EGD. I will first have the EGD
during which biopsies and a Bravo clip will be placed. I told him the Bravo
would possibly not find conclusive results due to possible alkaline reflux,
but they are going to do it anyway. Then, if I am not ruled out during the
EGD by a large hiatal hernia, Barrett's, esophagitis, etc., the manometry
will be done. He said they had just ordered a new manometry testing device
which would make it a much easier and shorter test.

I feel relieved and hopeful again knowing they will be doing diagnostic
testing beforehand. I forgot to ask him how many Strettas he had done. I
hope that's not a big issue in success. I got thrown off because he
wouldn't even consider doing the EGD without sedation, but said possibly
only benadryl could be used or a valium like drug with no narcotics. I hope
I can negotiate for benadryl sedation only. I don't want any kind of an
emotional backlash which I believe I could get with a tranquilizer type of
drug and I'm glad he agreed that I don't need the narcotics. I know myself
well enough to know I could do the EGD without any sedation, just with extra
oxygen, as is the standard of care in many other countries, but he has to be
within his own comfort zone to do the procedure so I'm willing to be
flexible on it. We did discuss fundoplication and I told him my reasons for
ruling it out as an option for me at this time. He accepted my reasons and
I was grateful for that.

On he issue of hiatal hernia, he said he wouldn't do a Stretta if there was
a hernia of 3mm or more. I hope that is conservative enough. I hope the
exact mm of herniation - if any is found - will be on the test results so I
can make my own determination if I'm comfortable to go forward or not. I
may not be comfortable doing it if it's over 2mm. I want to have the best
chance of success. We did discuss the other possible roadblocks such as
resting pressure of LES, etc. It was a thorough consultation. -Blocks