Electrical stimulation of the lower oesophageal sphincter: an emerging therapy for treatment of GORD
Background: A significant proportion of gastro-oesophageal reflux patients remain unsatisfied with medical treatment and suffer from residual symptoms or quality-of-life issues. Anti-reflux surgery demonstrates excellent results in clinical trials, but is not widely utilized due to concerns of side effects, long-term failures and suboptimal results from low-volume centres. Hence, the search for a less invasive treatment has been an active area of clinical development. Electrical stimulation is increasingly utilized for various neuromuscular disorders and has recently emerged as a new minimally invasive treatment option for gastro-oesophageal reflux disease (GORD) by modulating the dysfunctional lower oesophageal sphincter.
Methods: This review article includes available data from five peer-reviewed publications summarizing three human trials. Abstracts from major international conferences provided additional long-term results and interim data on an ongoing international trial. Four published trials with animal data are also reported.
Results: Published in vivo animal studies showed that electrical stimulation can be safely used to enhance lower oesophageal sphincter pressure. Feasibility clinical trials with temporary stimulation reproduced this effect in GORD patients and demonstrated preservation of swallow function. Two long-term trials showed improvement in oesophageal acid exposure, GORD symptoms and proton pump inhibitor (PPI) medications use with minimal side effects.
Conclusions: Enhancement of the anti-reflux function of the lower oesophageal sphincter using electrical stimulation is a safe and effective GORD treatment and can potentially address the unmet need of patients who are unsatisfied with PPIs. Additional data will help in a wider adoption of this technology.