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Changes in GERD symptom scores correlate with improvement in esophageal acid exposure after the Stretta procedure

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Abstract

Background

Endoscopic radiofrequency energy delivery (Stretta) is effective for managing gastroesophageal reflux disease (GERD) in selected patients. One criticism, however, is a theory that a mechanism of action is partial desensitization of the esophageal body rather than a reduction in esophageal acid exposure. To resolve this question, this study sought to determine if there is a correlation between the improvement in GERD outcomes and esophageal acid exposure after Stretta.

Methods

Subgroup analyses were performed between “responder” and “nonresponder” groups from the U.S. Stretta open label trial (n = 118), on the basis of posttreatment responses for GERD health-related quality of life (HRQL) heartburn, satisfaction, and proton pump inhibitor use. Outcomes were analyzed within and between subgroups. Pearson correlation coefficient analysis was performed comparing distal esophageal acid exposure with each of the continuous outcomes (GERD-HRQL, heartburn, satisfaction).

Results

Responder subgroups had significant improvements in esophageal acid exposure, whereas nonresponders had no change or less improvement in the same. Changes in GERD-HRQL and heartburn severity were correlated with changes in acid exposure (r = 0.16, p = 0.12 and r = 0.26, p = 0.01, respectively). Changes in satisfaction were negatively correlated with changes in esophageal acid exposure (r = 0.23, p = 0.02) because satisfaction, as expected, increased as acid exposure decreased.

Conclusions

Responders had significant improvement in esophageal acid exposure, whereas nonresponders had less or no change. There was a positive correlation between esophageal acid exposure and both GERD-HRQL and heartburn. This evidence suggests that symptomatic improvement after Stretta is attributable to a decrease in esophageal acid exposure and not to desensitization of the esophagus.

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Acknowledgments

The Stretta open trial investigators’ group is acknowledged for conducting this study. This group includes the gastroenterology and Otolaryngology Head and Neck Surgery Divisions, Stanford University School of Medicine (George Triadafilopoulos, MD, David S. Utley, MD, and Michael Kim, MD), Stanford, CA; the Division of Gastroenterology, Department of Medicine, University of Nebraska, Omaha, NE (John K. DiBaise, MD); the University of Michigan Hospital, Ann Arbor, MI (Timothy T. Nostrant, MD, and John C. Rabine, MD); the University of Miami/Miami VA Medical Center, Miami, FL (Neil H. Stollman, MD); the Dallas Diagnostic Association, Dallas, TX (Paul K. Anderson, MD); the Graduate Hospital, Philadelphia, PA (Donald O. Castell, MD, and Steven A. Edmundowicz, MD), the University of California San Francisco (Douglas A. Corley, MD, and Marco G. Patti, MD), the Boston Medical Center (Michael M. Wolfe, MD), the University of Louisville (John M. Wo, MD), the Dartmouth Hitchcock Medical Center (Richard D. Rothstein, MD), and the Rochester (Louis Antignano, MD) and Rocky Mountain Gastroenterology Associates (John S. Goff, MD).

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Authors and Affiliations

  1. Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, and the Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 3801 Miranda Avenue, Palo Alto, Stanford CA, 94304, USA

    G. Triadafilopoulos

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Correspondence to G. Triadafilopoulos .

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Triadafilopoulos , G. Changes in GERD symptom scores correlate with improvement in esophageal acid exposure after the Stretta procedure. Surg Endosc 18, 1038–1044 (2004). https://doi.org/10.1007/s00464-003-8243-5

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  • DOI: https://doi.org/10.1007/s00464-003-8243-5

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