Many people suffer from occasional acid reflux, but for some it becomes a chronic problem that can lead to ulcers and potentially cancer. Matthew Foster, 28, a Royal Engineer who lives near Ripon, North Yorkshire, underwent a new NHS procedure, as he tells CAROL DAVIS.
All my life I’ve kept pretty fit, eaten healthily and had no health worries. But around five years ago I started having a painful burning feeling in my throat after I’d been hurtling around the rugby field, or if I’d been for a jog. I knew it was heartburn, though didn’t think much could be done so I just bought over-the-counter remedies — Gaviscon liquid helped, and so did Rennie tablets, which I’d take after food or exercise.
But I was gradually having to take more and more — in just one day I’d get through a packet of Rennies and a whole bottle of Gaviscon.If I went for a pint with my mates I’d have to take a sip of Gaviscon before going out, and then again as soon as I got back to stop the painful burning.
Two years ago — around three years after the problem first started — I went to my GP, who confirmed that it was acid reflux causing my symptoms. He explained that acidic juices from my stomach were rising up into my throat because the valve separating the gullet and stomach was too weak to keep them down.
He suspected that this had been partly caused by a small hiatus hernia he said I had — basically part of my stomach was being squeezed, pushing the stomach contents up the gullet. I was prescribed lansoprazole, which reduces the amount of acid your stomach produces, and referred to the James Cook University Hospital in Middlesbrough for more tests.
Two months later I had an endoscopy — where they put a flexible tube with a camera on the end down your throat — and a special X-ray called a barium swallow to see where the stomach acid was in my gullet.
These confirmed I had a hiatus hernia and acid reflux which needed treatment with surgery. The doctors told me they could operate to wrap part of my stomach around the bottom of the gullet — this would strengthen the valve and stop acid washing back up. But that sounded like a major operation, and I really didn’t want that. So I went on taking the lansoprazole daily.
I even tried avoiding things that made it worse, such as pastry and lager.
It wasn’t enough though, and the heartburn got unbearable. After training I’d be sick as acid washed back up my throat — exercise clearly put extra strain on my stomach. I also didn’t like the idea of being on pills for life, so I got referred back to the James Cook.
This time I saw Dr Y.K.S. Viswanath, who said they was a new procedure to end acid reflux without surgery. It involves putting a tube with electrodes at the end down my throat and onto the faulty valve. The electrodes fire radiofrequency waves at the valve to strengthen it and help it close properly. I had the hour-long procedure in April this year, under local anaesthetic. I could feel the tube going down my throat, and it hurt each time a blast of radiofrequency burnt the tissue.
I went home that afternoon, with instructions to keep to a liquid diet for two weeks while my throat healed. I took co-codamol for a few days, then I was fine.
Now I can eat and drink what I want, and I don’t need to take anything. It’s a miracle operation — there is no more heartburn, even when I train hard or go out for a pint, which is wonderful.
Y.K.S. Viswanath is a consultant upper gastrointestinal and laparoscopic surgeon at the James Cook University Hospital.
Acid reflux or gastro-oesophageal reflux disease (GORD) is very common, affecting one in three of us. It occurs when the sphincter, a valve between the stomach and gullet, doesn’t work properly, allowing stomach acid to wash back up the gullet and causing heartburn.
Normally the valve opens to allow fluid and food to pass into the stomach, and closes to prevent these flowing back up the oesophagus. In GORD, the muscles in the valve are weakened, often as a result of lifestyle factors such as obesity, smoking or diet — spicy food and caffeine can irritate it — so it doesn’t close as it should.
Some patients have acid reflux that’s made worse by a hiatus hernia — where part of the stomach protrudes above the diaphragm into the chest, squeezing the stomach contents back up.
This is problematic as chronic acid reflux can lead to ulcers, bleeding and the pre-cancerous condition Barrett’s oesophagus. Lifestyle changes, for instance avoiding caffeine and citrus fruit (which can increase the amount of stomach acid) can help.
Antacids such as Gaviscon, which coats the stomach lining to stop acid rising, are also worth trying, or doctors can prescribe drugs to reduce stomach acid, which patients usually have to take for life.
When these fail, we can offer surgery. Conventionally this means a keyhole procedure to wrap part of the stomach around the gullet, which strengthens the valve. But not all patients are suitable for or want surgery, so a newer option, called Stretta, is better.
It has been approved for use in the NHS and is now available at two NHS trusts (at South Tees Hospitals NHS Foundation Trust and the Royal Liverpool And Broadgreen University Hospitals NHS Trust) as well as privately.
It involves passing a catheter, a tube which is roughly 16-18 mm in diameter, down the throat. At the end of the catheter are tiny prongs that fire radiofrequency waves — a low voltage electrical current — at the valve.
This damages the tissue and causes tiny scars — as these heal, new tissue forms and the valve becomes bulkier and stronger. The procedure takes up to 60 minutes, usually with the patient under sedation. First we spray local anaesthetic down the throat. Then we pass a camera down so we can identify exactly where the valve is.
We pass a guide wire down to the sphincter, and over that we feed the Stretta catheter until the prongs are in the right place. We fire for two one-minute spells on one side, and then move it down and give more cycles — 14 in all.Then we withdraw the catheter. We give the patient a drink straight after to check the swallowing reflex works and that we haven’t damaged any tissue.
The patient goes home that afternoon. They need to stick to a liquid diet for two weeks to allow the area to heal. They can also take Calpol liquid if they need painkillers.
Thanks to NICE approving Stretta for use three years ago, it is available on the NHS and will be adopted by more NHS trusts.
Although it is not suitable for everyone, it is a solution to heartburn without the need for surgery or patients being on long-term medication.
The procedure costs around £5,000-£5,500 privately, or £3,000 to the NHS.
You can read Matthew's story on Daily Mail: http://www.dailymail.co.uk/health/article-3696002/Me-operation-acid-reflux.html