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Heartburn Awareness with Surgical Options
Dr. Benjamin Leong discusses symptoms of heartburn, and the surgical treatment options available.
Featured Speaker:
He also completed fellowships in minimally invasive surgery and robotic surgery from the University of Texas, Houston. During his fellowship training, Dr. Leong gained valuable experience in bariatric surgery as well as advanced laparoscopic surgery.
Benjamin Leong, MD
Dr. Benjamin Leong received his bachelor degree from the University of California, Los Angeles and his doctorate in medicine from the Medical College of Ohio. After medical school, Dr. Leong completed a general surgery residency at New York Medical College.He also completed fellowships in minimally invasive surgery and robotic surgery from the University of Texas, Houston. During his fellowship training, Dr. Leong gained valuable experience in bariatric surgery as well as advanced laparoscopic surgery.
Transcription:
Melanie Cole (Host): If your current heartburn treatment is not giving you the results you want, and you’d like to maybe reduce or eliminate dependence on certain medications, there is another option, including a new minimally invasive procedure called LINX. My guest to tell us about this today is Dr. Benjamin Leong. He’s a minimally invasive and foregut surgeon and a member of the medical staff at Temecula Valley Hospital. Dr. Leong, I’m so glad to have you joining us, as many, many, many people suffer from GERD. Tell us about sort of the first line of defense. What are the typical treatments for GERD once somebody is diagnosed with it?
Dr. Benjamin Leong (Guest): Well thank you Melanie. You’re right, it’s a very common disease. In fact, one out of five Americans experience pretty consistent GERD symptoms. Almost everyone in their lifetime has some experience about GERD. So the first line defense, since it is such a common disease is to go less aggressive such as lifestyle modifications and some antacids, and if that helps their symptoms and the symptoms don’t come back, then I would say that’s the appropriate treatment at that time.
Host: Then talk about other treatments that are available. If people have been on medication, it hasn’t worked, they tried some lifestyle behavior modifications, they have not really done the trick; tell us about LINX. What is it? How does it work?
Dr. Leong: Well let’s say someone’s already on medications daily and they still have symptoms or someone who’s on medications, but they don’t want to be on medications long term. There are other procedures available to fix the reflux, which is causing the symptoms. The acid from the stomach is moving up to the esophagus. What we need to do is prevent that from happening. So traditionally the surgery is done by fixing the defects in the lower part of your esophagus where there’s a little bit of a hernia in the diaphragm. It’s called a diaphragmatic hernia. So the first step to do is to fix that defect, and the second step is to reinforce that valve in the lower part of the esophagus to prevent the acid from moving up. The traditional surgery for this is what we call Nissen fundoplication; however, the data has shown in the last 30 years that the results are not that great if you follow these patients 3 to 5 years out. Most of the patients are very happy in the first 3 years after this gold standard traditional surgery, but if you follow them 3 to 5 years out, up to 30% to 50% will start feeling recurrence of their symptoms. So in about 10 years ago, we have a new procedure called LINX, and this was a revolutionary procedure in the beginning, and I was not on board in the beginning because I want to see 5 year data, and after we see this 5 year data, what I’m seeing is that patients are doing really well with this procedure. It is able to prevent any reflux and regurgitation in about 85% of people even after 5 years out. The procedure is done almost like the traditional surgery. You fix the hernia. You bring the stomach back down to the abdomen from the chest, and then you put the LINX device in the lower part of the esophagus. Not to replace your valve or sphincter in the lower part of the esophagus; what it does is it augments the valve, strengthens the valve with this magnet strip.
Host: Wow, isn’t that cool? So who’s a good candidate for this procedure, and can you feel that implanted LINX with the magnet?
Dr. Leong: Well, that’s a great question. Not everyone should have this procedure. Everyone who has chronic reflux, already on medication for a while, they should have their esophagus and stomach evaluated, and if there are not major symptoms, these patients should stay on medications. So let’s say someone had persistent reflux and there’s a defect, and during their workup, there’s a lot of regurgitation and we find out you have a lot of acid in the lower part of the esophagus, this is the ideal patient. This is the patient we can help. There are many causes for symptoms that may or may not be reflux related. Let’s say someone has chest pain, they think it’s reflux, but it may be from something else. It could be musculoskeletal or it could be even heart disease causing chest pain. So the first thing to do is to get evaluated, and then after you get that evaluated we will know if you are a good candidate because we can tell how much reflux is coming up from your stomach to the esophagus, how much acid is coming up from the stomach to the esophagus, and these patients also can get evaluated for the size of a defect, or what we call hernia, in the lower part of the diaphragm and in the appropriate setting, we can fix the diaphragm and augment the sphincter so that reflux does not happen. The other question you ask me is do patients feel this device? That’s a very good question. In the beginning, I would say in the first two to four weeks, they are not used to the device, so they have to get used to the device by eating periodically, and then after they get used to the device, they will not notice the device there anymore after about 4 weeks. It’s like when someone puts on a jacket, the first 10 seconds, they still notice that the jackets on them, but after a while, their body adjusts and they don’t even notice that they’re wearing a jacket anymore. So it’s almost like that.
Host: Dr. Leong, we’re all different sizes. So how is this LINX device sized? Is it the same size for everybody? Does it size differently? I’m only 4 foot 10, would it be different for me than for you?
Dr. Leong: The sizing of the device is not based on height or based on how someone looks like from the outside. The sizing of the device is very carefully measured by evaluating the size of your esophagus. So after we fix the hiatal hernia, the next step is to look at your lower part of your esophagus and we have a device to measure how wide your esophagus is, and this device is specifically sized for that individual. So males tend to have a bigger esophagus so they would have the bigger size. Females tend to have a smaller esophagus, so they’re usually about two sizes smaller, so the size really depends on the size of the esophagus.
Host: Thank you for clearing that up. When can somebody eat normally again? And because this has a magnet, is there an issue with MRI in the future or airport security? Tell us a little bit about life after the procedure.
Dr. Leong: Well after a procedure like this, we hope that we can change your life for the better. In fact, most patients are very happy about their diet right after surgery because we tell them to eat what we call a soft diet, essentially it’s almost a regular diet, and we want them to eat normally and advance their diet as quickly as they can. And in terms of how this will effect your lifestyle, if you go through the airport, we will give you a medical device card. If there is any reason why they would stop you, you would have a medical device card. There’s a lot of implants in patients nowadays and airport security is aware of that, and usually it’s not a problem. If there is a problem, you get a device card that will tell them I have a surgical implanted device, but in terms of MRI and other medical testing and things like that sort in the future. It’s not a problem. The only problem with MRI is if you go to a 3.0 tesla MRI, which is only in 20% of the facilities and this is a very unusual MRI machine. Most facilities, 80% of the facilities, only have 1.5 tesla MRI. Let’s say for some reason you went to a 3.0 tesla MRI, it does not hurt you might it might demagnetize the LINX device and it may not work as well, but it will not harm the patient.
Host: As we were discussing in the beginning, doctor, about why people might even consider this, after it’s done do they still have to take those GERD medications, or do they get to not take those anymore?
Dr. Leong: Good question, so if someone has the LINX procedure, the next day we tell them to stop taking medications altogether. Some patients are on two or three medications and we tell them to stop everything immediately, and from my experience most patients are very happy with this because the symptoms pretty much disappear immediately after the procedure.
Host: Wow, I bet people are happy about that because not everyone likes to take medications. Is this a permanent fix? Is it something that lasts or might have to be redone?
Dr. Leong: This is a permanent fix. We have five year data showing 85% of patients who are still off medications and have no symptoms, and 99% of patients who had regurgitation, meaning fluid from the stomach moving through the esophagus, show no signs of regurgitation. So after 5 years, I think the evidence is strong enough to recommend it to the broad public. I think that is a – speaks to what we would expect someone in 5, 10, 15 years to have.
Host: It’s great information Dr. Leong. Wrap it up for us. What would you like us to know about GERD, and since it can sometimes be silent, what would you like people to know about searching out options, getting diagnosed, and then even considering the LINX procedure?
Dr. Leong: Well GERD is a very common disease. I would say almost everyone would experience some sort of reflux at one point or another in their lifetime. I would say if you experience intermittent symptoms, it would be appropriate to just treat it with over the counter medications. For those patients who are already on medications long term because they have persistent symptoms, I would recommend those patients have their esophagus and stomach evaluated to make sure there’s no injury from the acid from the stomach moving to the esophagus, and in certain populations where there is injury or the patient’s already on medications and still have a lot of symptoms, they can be evaluated to see if there’s a hernia and if there’s significant regurgitation or acid reflux back to the esophagus. In these patients there’s a good cure for this. A simple surgical procedure, which can be done outpatient or overnight, can relieve long term and lifetime of symptoms, and these patients the first step that they need to do is get evaluated by their GI doctor and get the appropriate tests, and after these appropriate tests, they can come see a surgeon and the surgeon can evaluate them if they’re a good candidate for the LINX procedure.
Host: Thank you so much Dr. Leong for sharing your expertise and explaining this procedure so very well for us, and for the many sufferers of heartburn and GERD. Thank you so much for listening to this episode of TVH Health Chat with Temecula Valley Hospital. Head on over to our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. Physicians are independent practioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.
Melanie Cole (Host): If your current heartburn treatment is not giving you the results you want, and you’d like to maybe reduce or eliminate dependence on certain medications, there is another option, including a new minimally invasive procedure called LINX. My guest to tell us about this today is Dr. Benjamin Leong. He’s a minimally invasive and foregut surgeon and a member of the medical staff at Temecula Valley Hospital. Dr. Leong, I’m so glad to have you joining us, as many, many, many people suffer from GERD. Tell us about sort of the first line of defense. What are the typical treatments for GERD once somebody is diagnosed with it?
Dr. Benjamin Leong (Guest): Well thank you Melanie. You’re right, it’s a very common disease. In fact, one out of five Americans experience pretty consistent GERD symptoms. Almost everyone in their lifetime has some experience about GERD. So the first line defense, since it is such a common disease is to go less aggressive such as lifestyle modifications and some antacids, and if that helps their symptoms and the symptoms don’t come back, then I would say that’s the appropriate treatment at that time.
Host: Then talk about other treatments that are available. If people have been on medication, it hasn’t worked, they tried some lifestyle behavior modifications, they have not really done the trick; tell us about LINX. What is it? How does it work?
Dr. Leong: Well let’s say someone’s already on medications daily and they still have symptoms or someone who’s on medications, but they don’t want to be on medications long term. There are other procedures available to fix the reflux, which is causing the symptoms. The acid from the stomach is moving up to the esophagus. What we need to do is prevent that from happening. So traditionally the surgery is done by fixing the defects in the lower part of your esophagus where there’s a little bit of a hernia in the diaphragm. It’s called a diaphragmatic hernia. So the first step to do is to fix that defect, and the second step is to reinforce that valve in the lower part of the esophagus to prevent the acid from moving up. The traditional surgery for this is what we call Nissen fundoplication; however, the data has shown in the last 30 years that the results are not that great if you follow these patients 3 to 5 years out. Most of the patients are very happy in the first 3 years after this gold standard traditional surgery, but if you follow them 3 to 5 years out, up to 30% to 50% will start feeling recurrence of their symptoms. So in about 10 years ago, we have a new procedure called LINX, and this was a revolutionary procedure in the beginning, and I was not on board in the beginning because I want to see 5 year data, and after we see this 5 year data, what I’m seeing is that patients are doing really well with this procedure. It is able to prevent any reflux and regurgitation in about 85% of people even after 5 years out. The procedure is done almost like the traditional surgery. You fix the hernia. You bring the stomach back down to the abdomen from the chest, and then you put the LINX device in the lower part of the esophagus. Not to replace your valve or sphincter in the lower part of the esophagus; what it does is it augments the valve, strengthens the valve with this magnet strip.
Host: Wow, isn’t that cool? So who’s a good candidate for this procedure, and can you feel that implanted LINX with the magnet?
Dr. Leong: Well, that’s a great question. Not everyone should have this procedure. Everyone who has chronic reflux, already on medication for a while, they should have their esophagus and stomach evaluated, and if there are not major symptoms, these patients should stay on medications. So let’s say someone had persistent reflux and there’s a defect, and during their workup, there’s a lot of regurgitation and we find out you have a lot of acid in the lower part of the esophagus, this is the ideal patient. This is the patient we can help. There are many causes for symptoms that may or may not be reflux related. Let’s say someone has chest pain, they think it’s reflux, but it may be from something else. It could be musculoskeletal or it could be even heart disease causing chest pain. So the first thing to do is to get evaluated, and then after you get that evaluated we will know if you are a good candidate because we can tell how much reflux is coming up from your stomach to the esophagus, how much acid is coming up from the stomach to the esophagus, and these patients also can get evaluated for the size of a defect, or what we call hernia, in the lower part of the diaphragm and in the appropriate setting, we can fix the diaphragm and augment the sphincter so that reflux does not happen. The other question you ask me is do patients feel this device? That’s a very good question. In the beginning, I would say in the first two to four weeks, they are not used to the device, so they have to get used to the device by eating periodically, and then after they get used to the device, they will not notice the device there anymore after about 4 weeks. It’s like when someone puts on a jacket, the first 10 seconds, they still notice that the jackets on them, but after a while, their body adjusts and they don’t even notice that they’re wearing a jacket anymore. So it’s almost like that.
Host: Dr. Leong, we’re all different sizes. So how is this LINX device sized? Is it the same size for everybody? Does it size differently? I’m only 4 foot 10, would it be different for me than for you?
Dr. Leong: The sizing of the device is not based on height or based on how someone looks like from the outside. The sizing of the device is very carefully measured by evaluating the size of your esophagus. So after we fix the hiatal hernia, the next step is to look at your lower part of your esophagus and we have a device to measure how wide your esophagus is, and this device is specifically sized for that individual. So males tend to have a bigger esophagus so they would have the bigger size. Females tend to have a smaller esophagus, so they’re usually about two sizes smaller, so the size really depends on the size of the esophagus.
Host: Thank you for clearing that up. When can somebody eat normally again? And because this has a magnet, is there an issue with MRI in the future or airport security? Tell us a little bit about life after the procedure.
Dr. Leong: Well after a procedure like this, we hope that we can change your life for the better. In fact, most patients are very happy about their diet right after surgery because we tell them to eat what we call a soft diet, essentially it’s almost a regular diet, and we want them to eat normally and advance their diet as quickly as they can. And in terms of how this will effect your lifestyle, if you go through the airport, we will give you a medical device card. If there is any reason why they would stop you, you would have a medical device card. There’s a lot of implants in patients nowadays and airport security is aware of that, and usually it’s not a problem. If there is a problem, you get a device card that will tell them I have a surgical implanted device, but in terms of MRI and other medical testing and things like that sort in the future. It’s not a problem. The only problem with MRI is if you go to a 3.0 tesla MRI, which is only in 20% of the facilities and this is a very unusual MRI machine. Most facilities, 80% of the facilities, only have 1.5 tesla MRI. Let’s say for some reason you went to a 3.0 tesla MRI, it does not hurt you might it might demagnetize the LINX device and it may not work as well, but it will not harm the patient.
Host: As we were discussing in the beginning, doctor, about why people might even consider this, after it’s done do they still have to take those GERD medications, or do they get to not take those anymore?
Dr. Leong: Good question, so if someone has the LINX procedure, the next day we tell them to stop taking medications altogether. Some patients are on two or three medications and we tell them to stop everything immediately, and from my experience most patients are very happy with this because the symptoms pretty much disappear immediately after the procedure.
Host: Wow, I bet people are happy about that because not everyone likes to take medications. Is this a permanent fix? Is it something that lasts or might have to be redone?
Dr. Leong: This is a permanent fix. We have five year data showing 85% of patients who are still off medications and have no symptoms, and 99% of patients who had regurgitation, meaning fluid from the stomach moving through the esophagus, show no signs of regurgitation. So after 5 years, I think the evidence is strong enough to recommend it to the broad public. I think that is a – speaks to what we would expect someone in 5, 10, 15 years to have.
Host: It’s great information Dr. Leong. Wrap it up for us. What would you like us to know about GERD, and since it can sometimes be silent, what would you like people to know about searching out options, getting diagnosed, and then even considering the LINX procedure?
Dr. Leong: Well GERD is a very common disease. I would say almost everyone would experience some sort of reflux at one point or another in their lifetime. I would say if you experience intermittent symptoms, it would be appropriate to just treat it with over the counter medications. For those patients who are already on medications long term because they have persistent symptoms, I would recommend those patients have their esophagus and stomach evaluated to make sure there’s no injury from the acid from the stomach moving to the esophagus, and in certain populations where there is injury or the patient’s already on medications and still have a lot of symptoms, they can be evaluated to see if there’s a hernia and if there’s significant regurgitation or acid reflux back to the esophagus. In these patients there’s a good cure for this. A simple surgical procedure, which can be done outpatient or overnight, can relieve long term and lifetime of symptoms, and these patients the first step that they need to do is get evaluated by their GI doctor and get the appropriate tests, and after these appropriate tests, they can come see a surgeon and the surgeon can evaluate them if they’re a good candidate for the LINX procedure.
Host: Thank you so much Dr. Leong for sharing your expertise and explaining this procedure so very well for us, and for the many sufferers of heartburn and GERD. Thank you so much for listening to this episode of TVH Health Chat with Temecula Valley Hospital. Head on over to our website at temeculavalleyhospital.com for more information and to get connected with one of our providers. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. Physicians are independent practioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole.