Abstract & Commentary
Synopsis: Radiofrequency energy delivered to the esophageal lumen at the gastroesophageal junction achieves short-term symptom relief in patients with relatively mild GERD.
Source: DiBaise JK, et al. Am J Gastroenterol. 2002;97: 833-842.
GERD is common, highly bothersome, and consumes substantial health care resources. Since it is thought that inappropriate transient lower esophageal sphincter relaxations (TLESRs) may mediate GERD, new therapies are being developed to inhibit such relaxations. One of these is the delivery of radiofrequency energy (RFE) by a transoral balloon catheter to the area of the lower esophageal sphincter. Animal and some human studies appear to validate this approach, and the present study was designed to further explore this procedure. Eighteen patients who previously had some relief from PPIs or high-dose H2RAs underwent this outpatient treatment without any serious adverse event, and symptom scores were significantly (but modestly) improved at 6 months. DiBaise and colleagues (and others) are promoting this technique as an alternative to long-term medical management of mild-to-moderate GERD. No significant effect was seen on esophageal acid exposure or any esophageal motility parameter, although there was a trend toward decreased TLESRs and, possibly, some thickening of the distal esophageal wall.
Comment by Malcolm Robinson MD, FACP, FACG
In a disease that almost always can be treated effectively with extremely safe medical therapy, it is hard to understand the continuing focus on invasive procedures for GERD treatment. This study and others that have tested RFE all have failed to show any definite effect on motility or on esophageal acidity. Although there may be slight effects on TLESRs, this is also uncertain. Several critics of this procedure have suggested that effects could be mediated by the destruction of esophageal submucosal innervation. There is no long-term experience with this technique. Therefore, like other endoscopic approaches to GERD, RFE cannot be recommended on other than an investigational basis despite great enthusiasm by many community gastroenterologists. The effects of RFE after many years could include dysphagia, stricture, or even neoplasia. At least in the mind of this reviewer, patients should be strongly discouraged from considering such alternative GERD management.
Dr. Robinson, Medical Director, Oklahoma Foundation for Digestive Research; Clinical Professor of Medicine, University of Oklahoma College of Medicine, Oklahoma City, is Associate Editor of Internal Medicine Alert.
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