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"The diet associated with less reflux symptoms is generally in keeping with what we consider to be a healthy diet — low in concentrated sweets, red meat and refined grains," Dr. Chan says. Women who regularly take medication for GERD, including proton pump inhibitors (PPIs) a nd hista mine-2 receptor antagonists (H2R As), a lso reported a reduced occurrence of symptoms. NEW ENDOSCOPIC DEVICE PROMISING FOR PPI-DEPENDENT PATIENTS Researchers in India found that the placement of an endoscopic full-thickness fundoplication device (EFTP) called the GERDx in patients on long-term PPI therapy can replace the need for a more invasive surgical procedure. "Our study found endoscopic full-thickness fundoplication was safe and significantly improved GERD-related quality of life and severity of reflux symptoms at short and long terms, compared with a sham procedure," according to Rakesh Kalapala, MD, Director of Endoscopy at the Center for Obesity and Metabolic Therapy, part of the Asian Institute of Gastroenterology in Hyderabad, and colleagues in an article in Gut. EFTP utilizes transmural sutures, which are applied at the gastroesophageal junction to help restructure the gastric cardia and strengthen the valvular mechanism. Other EFTP devices are available, but the GERDx device has distinct advantages, according to Dr. Kalapala and colleagues. "Compared with other EFTP devices, GERDx appears to be simpler, less cumbersome with a shorter procedure time and safer," note the study authors. The small randomized controlled trial revealed that the GERDx device improved health-related quality of life by 67.5% or more at three months for patients in the EFTP group, as compared to only 2.9% in the sham or control group. By the six-month marker, this fraction climbed to 81.4% and 8.0%, respectively, and at 12 months, to 92.3% and 9.1%. Researchers also saw significant improvements in overall GERD symptoms for EFTP patients. At 12 months, 62.8% of these patients were able to discontinue PPIs, as compared to 11.4% of sham patients. However, the GERDx device led to only a slight improvement in esophageal acid exposure. "Improvement in GERD-HRQL [Health-Related Quality of Life, a patient-reported outcomes scale] may be a more relevant and patient-centric goal as compared with normalization of esophageal acid exposure, which is infrequent with the currently available devices," the authors write. Dr. Kalapala and colleagues also note that patient selection is very important. "Preferred cohort of patients who would benefit from EFTP includes those with PPI dependence, abnormal acid or non-acid reflux and small hiatus hernia," the authors write. While larger trials are needed, the GERDx device is a promising alternative therapy for patients who are opposed to surgery and who wish to discontinue PPIs. n M D N E W S . C O M /// M D N E W S C E N T R A l P E N N S y lVA N i A ■ 2 0 21 1 5