Radiofrequency Energy Effective in GERD

Laurie Barclay, MD

April 17, 2003

April 17, 2003 — Radiofrequency energy delivered to the lower esophageal sphincter via endoscopy improves gastroesophageal reflux disease (GERD), according to the results of a study published in the April issue of Gut.

"Radiofrequency energy (RFe) treatment to the lower esophageal sphincter and gastric cardia is a new luminally delivered therapy proposed as an alternative treatment for GERD," write W. C. E. Tam, from Royal Adelaide Hospital in North Terrace, SA, Australia, and colleagues. "However, it is unclear how RFe achieves its antireflux effect."

Twenty patients with GERD had endoscopy, symptom evaluation, and combined postprandial esophageal manometry and pH monitoring before and six months after RFe. In addition, they had 24-hour ambulatory pH monitoring before and at six and 12 months after treatment.

The rate of postprandial transient lower esophageal sphincter relaxations decreased from a median of 6.8 (interquartile range, 5.7 - 8.1) per hour at baseline to 5.2 (4.2 - 5.8) per hour ( P < .01) after RFe treatment. Concomitantly, mean basal lower esophageal pressure increased from 5.2 ± 0.3 mm Hg to 8.0 ± 0.4 mm Hg ( P < .01). The number of reflux episodes decreased from 10 (interquartile range, 2 - 15.3) per three-hour period to 5 (interquartile range, 3.5 - 8.5) per three-hour period ( P < .05), while acid exposure time decreased from 5.4% (interquartile range, 0.4% - 14.7%) to 3.9% (interquartile range, 0.4% - 6.6%; P < .05).

Although all patients required acid suppressant medication before RFe, 15 patients (75%) were in symptomatic remission six months after treatment, and 13 patients (65%) were in remission 12 months after treatment. Ambulatory esophageal acid exposure went from 10.6% (interquartile range, 7.8% - 13.0%) at baseline to 6.8% (interquartile range, 3.1% - 9.1%; P < .01) six months after treatment and 6.3% (interquartile range, 4.7% - 10.9%; P < .05) 12 months after treatment.

"RFe has significant effects on [lower esophageal sphincter] function that are associated with improvement in the antireflux barrier," the authors write. "Uncontrolled clinical data also suggest a beneficial effect in the control of reflux symptoms in these patients. Further studies are needed to evaluate the mechanism of effects on transient lower esophageal sphincter relaxations, and to gather placebo-controlled data with long-term follow-up."

Gut. 2003;52:479-485

Reviewed by Gary D. Vogin, MD