Transcription:

Melanie Cole (Host):  If you have reflux or GERD and you experience frequent heartburn and other symptoms that negatively affect your quality of life; and despite medication you still have symptoms, you might be interested in the LINX Reflux Management System.  My guest today is Dr. Paul Toomey, he is a board certified general surgeon and a member of the medical staff at Manatee Memorial Hospital.  Welcome to the show Dr. Toomey.  So, first speak about the first line of defense if you meet somebody and they have GERD, they’ve had it for a while, what’s the first thing they typically do?

Dr. Paul Toomey (Guest):  Well, typically they use medication over the counter.  They’re a multitude of different types of medications and the important thing of over the counter medications are knowing which ones are good for now and which ones are good for stave it off later and which ones are good for if you’re going to have it for prolonged period.  So, the common things over the counter that you would use or that are immediate effects are things like Maalox or Tums.  Whereas, if you us Zantac, that’s good before a meal if you think you’re going to have reflux.  And then if you’re going to have prolonged reflux then you want to use something called a proton pump inhibitor.  Most common ones are the Purple Pill or Nexium or Omeprazole over the counter which is the generic, but there are a host of other ones you could also use.

Melanie:  If medication intervention isn’t helping the situation, tell us about this LINX Reflux Management System.  And what is that?

Dr. Toomey:  The LINX Management System is a magnetic augmentation sphincter device that you place right at the gastroesophageal junction.  The junction between the esophagus and the stomach is normally supposed to allow food to go down, but then whenever your stomach pressurizes help stop from reflux.  We all normally have reflux, but not all of us have reflux to the point that it’s pathological where they’re having daily chest pain or regurgitation.  So, what this does, is essentially augment that exact sphincter mechanism that we’re supposed to have by putting these magnetic cores wrapped in titanium that are beads in a circular fashion right where the gastroesophageal junction is.  This device is not to impinge on the esophagus; it actually just sits right snug to it.  So, whenever you swallow food, it breaks the magnetic bonds between the beads and allows food to go down.  But if your stomach pressurizes to a point that it wants to reflux up into the contents of the stomach up into the esophagus, it has enough augmentation of the sphincter so that it avoids all of those symptoms of reflux.

Melanie:  So, the gastric acids in a sense can’t push back up into the esophagus from the stomach.  So, as that happens, how long does something like this stay in place?  Is it permanent?

Dr. Toomey:  This is for lifelong.  You know, it’s made with titanium outer portion of the magnetic core is titanium wrapped, so.  This is just like any other device like a knee or hip that supposed to be for a lifelong.

Melanie:  And then how is it put into place?  Is this a minimally invasive surgical procedure?  Tell us about that.

Dr. Toomey:  Yes, most people do it lacrascopicaly with the small incisions.  I’ve got it down to 3 incisions, I can probably do it in 2 incisions.  They’re really tiny incisions at laparoscopic.  Most do 5 small tiny incisions just like any other lacrascopic operation.  And so, we essentially make a small window right at that space and place the device and it takes anywhere from about 45 minutes to do.  It’s a day procedure, you go home the same day in my hands.

Melanie:  Dr. Toomey, what if the patient is obese, is there something that changes with this LINX device?

Dr. Toomey:  So, obesity is not a complete contraindication but it is a relative contraindication, actually the only complete contraindication is a metal allergy because of the titanium.  But there are multiple different reasons not to put a LINX device.  Obesity, for me, I would not put it in a patient with morbid obesity for instance.  My goal body mass index for any anti reflux operation, including the LINX is a BMI, a body mass index of 27.  Which is still not normal, it’s in the overweight category.  But obesity, the problem with obesity is you have intra bowel pressure that pushes up your stomach, that pushes up your acids.  So, that the real problem with obesity is the overweight abdomen and so if you can decrease the weight in your abdomen, then you can usually decrease the amount of reflux.  So, a lot of people that are overweight have the reflux symptoms and if they lose the weight a lot of their symptoms may go away.  So, I follow them and give them a diet, and follow them and if they continue to have symptoms after they have lost the weight then they will be considered for a candidate for the LINX.

Melanie:  Do they still take their heartburn medications even with the LINX system?

Dr. Toomey:  No, over 90% of patients at 5 years are typically off of their proton pump inhibiter, off their medications.  So, you really, one of the main things about doing any of these anti reflux operations is that you don’t need lifelong medications.  And some of the effects that have been found with long-term proton pump inhibiters such as osteoporosis or increased fractures are avoided especially for patients as they get older.

Melanie:  And what about something like the airport, does this mess around with security at the airport?

Dr. Toomey:  So, that’s a very common question.  No, it won’t even register.  But we do give everyone a card just in case there ever is anything funny, that they register.  But this does not go off at the airport.  The other common question that people have is MRI.  For an MRI, because it’s also a magnet, can you get an MRI.  The answer is yes, about 85% of the MRIs in the United States are a 1.5 tesla MRI machine.  And so, the majority MRIs you can get.  You just don’t want to get a very super specialized MRI that could demagnetize about a third of the beads.  It won’t pull it out or anything, it will just demagnetize and defunctionalize a third of it.  So, it may partially work, but it won’t work to the full effect.

Melanie:  What about side effects Dr. Toomey, would this limit your ability to say vomit if you’ve got stomach flu or to belch if you’ve got gas?

Dr. Toomey:  So, this is one of the advantages that we have with the LINX Reflux Management System is that you are able belch or vomit afterwards.  Because as long as your stomach pressurizes to a point that you really that will break that magnetic bond then you will be able to belch.  And so, normal reflux is avoided, but whenever your stomach pressurizes enough that you have to belch or vomit then it allows that.  Whereas the typical anti reflux operations that we’ve done in the past, the Nissen fundoplication, which is a stomach wrap around the esophagus to augment the sphincter in the same, similar manner really reconstructs it.  When the stomach pressurizes it makes that sphincter even tighter and so a lot of the times patients cannot belch or vomit whenever they have fundoplication.

Melanie:  Is there ever a situation when it might have to be removed?

Dr. Toomey:  Oh absolutely.  So, if a patient continues to have problems with the esophageal spasms for instance, or an erosion of the device.  Now the erosion that’s one of the reasons why it is important to wait for at least 5-year data before we really roll out with this.  And it shows that it’s very rare that a patient had any erosions of the device.  The human body is an amazing thing, and it envelopes all these beads independently and so if while after it’s enveloped it’s very unusual to migrate or move or anything like that.  So, it’s very safe, it stays in the same place.  Very low chance you will ever have to take it out.  But nothing is ever 100%, so absolutely if a patient had to have it removed, you can remove it, you can typically do it laparoscopically.

Melanie:  In the last few minutes, Dr. Toomey, what would you like people to know about LINX, this new procedure used for GERD, or even possible ways to prevent GERD?

Dr. Toomey:  Sure, so, the main thing about the LINX device is I think it’s even less invasive then we have been in the past with the fundoplication and so, if you’re really struggling with reflux, especially if you have a small hiatal hernia where your stomach is a little bit up in your chest, you may be a candidate for a LINX device and this avoids lifelong medications for you.  Which is actually a cost benefit in the long run.  The adverse effects of the proton pump inhibitors is not nil.  You can imagine by getting rid of the acid in your stomach, you’re allowing change in the microbiome or the 2 different bacteria that goes into your body.  And so, that is one issue and the second issue is the absorption of the minerals that we probably promote osteoporosis.  So, I think that this is a very minimally invasive way to combat gastroesophageal reflux disease.  And ultimately you have problems down the stream with the gastroesophageal reflux disease such as barrett esophagus change in the mucosa, your esophagus that is a premalignant curser for gastroesophageal cancer.

Melanie:  And why should they come to Manatee Memorial Hospital for their care?

Dr. Toomey:  So, Manatee Memorial, we can do this minimally invasively with special scopes where we do even less incisions that most people can do for the LINX operation.  It’s a day procedure.  The staff is friendly, the operating room staff is very efficient.  And I’m happy to be a member of Manatee Memorial Hospital.  I think it’s a great place to be a patient and to operate as a surgeon.

Melanie:  Thank you so much for being with us today Dr. Toomey.  You’re listening to Manatee talk radio with Manatee Memorial Hospital.  For more information, you can go to manateememorial.com.  That’s manateememorial.com.  Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital.  The hospital shall not be liable for actions or treatments provided by physicians.  This is Melanie Cole, thanks so much for listening.