Major UK newspaper article on TIF surgery with esophyx

1. The heartburn healer: New op can cure
the agony of acid reflux - with no
scarring
By David Hurst
Last updated at 8:29 AM on 16th March 2010
Acid reflux affects more than ten million Britons,
including many children, causing heartburn. Alex
Harding, 16, from Sheffield, was one of the first to have a
new, less invasive operation to treat the problem. He
talks to DAVID HURST.
THE PATIENT
Pain-free: Alex Harding was one of the first to have a new operation to treat acid
reflux
Four years ago, I started to get bad stomach ache and it felt as though acid was
burning my throat. I began to have it every day following meals and the pain lasted
about two hours. It was so bad that I'd have to sit down and wait for it to pass.
My parents were worried, but we all thought it was just indigestion.

2. But two years ago it got so bad it was there all day and night. I couldn't sleep, and I
was tired all the time. It really affected me at school, and I couldn't go out with friends
or play sport. It was very frustrating.
After two weeks, my parents said 'enough is enough' and I saw my GP, who referred
me to Sheffield Children's Hospital for tests. The consultant put a tube with a tiny
camera on the end down my throat and into my stomach. He also used a thing called a
PH probe to work out how much acid there was passing between my throat and
stomach.
First he threaded a thin, flexible tube through my nose. It took five minutes and I
wasn't given anaesthetic - it wasn't great. The tube was connected to a small computer
I wore around my waist for a day.
The tests showed I had acid reflux. Basically, acid from my stomach was coming up
past a faulty valve into my throat and mouth.
I was given strong indigestion tablets and told to avoid caffeine and spicy foods.
But the tablets didn't help and I put up with the condition for another year. Finally, it
became too much and I went back to the consultant. This time he sent me to an expert
in acid reflux in children - Dr Mike Thomson, who said I needed an operation.
I didn't fancy being cut open, but he explained there was a new procedure where they
could operate through my mouth.
I had the op in December 2008. It took only 40 minutes, and as soon as I woke up I
felt better. The heartburn and stomach ache had gone.
Now I can go out with my mates again and I play ice hockey every week. I'm just so
happy I can do all the things I want to do now - including becoming a primary school
teacher one day.
THE SURGEON
Mike Thomson is a consultant gastroenterologist at Sheffield Children's Hospital. He
says:
He says... When we swallow, a valve between the stomach and oesophagus - the
tube that runs between your throat and stomach - opens to allow food to pass through.
It then closes to prevent stomach acid coming back into the oesophagus.
However, many people have a weak or ineffective valve which leads to acid reflux or
gastro-oesophageal reflux disease (GORD). Around 20 per cent of people in Britain
experience acid reflux at least once a week.

3. For the majority of sufferers, symptoms are improved
with lifestyle changes such as eating smaller meals,
and avoiding caffeine, chocolate, alcohol and spicy
foods
Often the condition can become chronic, getting progressively worse. Symptoms
include heartburn, regurgitation and stomach ache.
Acid reflux can be caused by hormonal changes and increased pressure during
pregnancy. It can also occur in those with a dairy intolerance. Many people are just
born with it, though.
For the majority of sufferers, symptoms are improved with lifestyle changes such as
eating smaller meals, and avoiding caffeine, chocolate, alcohol and spicy foods.
There are medicines that neutralise the effects of stomach acid, such as Rennie, or
stronger versions like ranitidine and omeprazole. But if left untreated GORD can
inflame the oesophagus lining and cause internal scarring and ulcers. These ulcers can
bleed and lead to pain and anaemia.
Excess acid can also lead to inflammation in the lower oesophagus, which can cause
scarring and make swallowing hard.
Repeated episodes of GORD can lead to changes in the cells of the oesophagus lining:
a condition called Barrett's oesophagus. The cells are not cancerous, but there's a risk
they could become cancerous because the tissue is continually being burned by acidic
juices.
The traditional operation is a fundoplication, where the upper part of the stomach
closest to the entry of the oesophagus is gathered up and sewn around the oesophagus.
This 'tightens' the lower oesophagus to prevent acid leaking upwards.
The older version of this operation requires an 8in incision across the stomach, but
most hospitals now offer keyhole surgery.
The new procedure Alex had - the TIF (Transoral Incisionless Fundoplication) - was
developed in the U.S. and is basically the same as the traditional fundoplication but is
carried out through the mouth to avoid cutting the patient.
This procedure is quicker than the old operation and carries less risk of infection,
discomfort and visible scarring. Patients can be in and out of hospital in under a day.
The operation is like bringing the neck of a purse string together. With the patient
under general anaesthetic, the EsophyX device extends down through the mouth into
the patient's stomach. It then pulls and fastens a tissue fold by pleating and stitching it.
This step is repeated around 16 times to reconstruct a tight valve that prevents the
reflux of stomach acid.

4. Recent clinical studies show that two years after the procedure, 85 per cent of patients
are still heartburn free.
• The operation is available on the NHS and will save tens of thousands due to the
reduced amount of overnight stays. Privately it costs £5,000.
Read more: http://www.dailymail.co.uk/health/article-1258153/The-heartburn-healer-
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