Acid reflux pills are linked to worrying side-effects… but is surgery REALLY the answer?

Chicken, peas, and mashed potatoes might seem like a pretty normal meal to most people, but for Bradley Phelps, that dinner after surgery he had at a private hospital in March 2022 was the first normal meal he’d ever been able to eat. five years.

“It was great,” he says. ‘I no longer had the pain, nausea or acid in my mouth that I used to have with normal meals. I could not believe it.’

That day, Bradley became one of the first people in Britain to be treated with a marble-sized implant for gastroesophageal reflux disease (GERD), a chronic condition that now affects millions of adults.

With more and more people developing reflux due to obesity and lack of exercise, and concerns about the health risks of long-term use of over-the-counter proton pump inhibitors (PPIs) to treat it, there is likely to be increasing clamor for such surgery.

“I had been getting sicker and sicker for about 15 years and for the past five years I had been living on a piece of dry toast for breakfast and a roll with tea,” says Bradley, 71, a retired gardener who lives in Leicester with his wife Barbara, 69. .

He had first developed GORD in his mid-50s. By the time of his surgery, he says, eating more than small amounts of bland food was unbearable.

‘I had a pain in my throat 24 hours a day and my chest felt like there was an elastic band around it.’

Bradley is estimated to be one in four people in Britain who, according to the charity Heartburn Cancer UK, have been recommended PPIs, one of the world’s most commonly used acid reflux drugs. This is where stomach contents painfully bubble back up into the esophagus, the tube that carries food from the throat to the stomach.

Although some people are more susceptible to GORD as they age, obesity is the main factor behind the increase in cases.

Because about 70 percent of men and 60 percent of women are overweight or obese, these figures could help explain why more men than women suffer from it.

Triggers include spicy foods, citrus fruits, and caffeine, which can irritate the valve between the stomach and esophagus.

If the lining of the esophagus is repeatedly exposed to stomach acid, it can become damaged and scarred, causing it to narrow and making swallowing food difficult.

Exposure to stomach acid can also lead to Barrett’s esophagus, a growth of abnormal cells that cause pain, difficulty swallowing, the feeling of food getting stuck in the throat, an unpleasant taste in the mouth, and bad breath.

This abnormal cell growth can, in turn, lead to cancer. Cancer Research UK says the number of cases of oesophageal cancer has increased by 40 percent since the early 1970s, and the disease kills 8,000 people every year in Britain.

Yet there is mounting evidence linking PPIs – the very drugs that can reduce reflux – to longer-term harm.

In a recent study, researchers from six US universities looked at data from more than 5,700 people from the late 1980s and found that taking PPI drugs for more than 4.4 years was linked to a higher incidence of dementia in people over 45 years, the journal Neurology reported in August.

‘PPIs are thought to affect beta-amyloid, a type of protein,’ explains Chris Sutton, clinical director of upper gastrointestinal surgery at Leicester Royal Infirmary.

‘Buildup of beta-amyloid is associated with dementia. There is a naturally occurring enzyme in the brain called V-ATPase that clears beta-amyloid, but PPIs disrupt the production of that enzyme.”

Other studies have suggested that PPIs may reduce the absorption of vitamins and minerals from food, which has been linked to the development of osteoporosis, and may also allow the growth of harmful bacteria in the digestive system that would normally be killed by stomach acid .

‘PPIs work by blocking the production of acid in the stomach,’ says Mr Sutton.

‘The natural production of stomach acid kills bacteria. “Reducing the amount of acid in the stomach puts people at greater risk of food poisoning or infection with Clostridium difficile (a potentially serious infection).”

PPIs have been available without a prescription since 2015. It is feared that many patients will continue to take it for years, even though the NHS website, for example, says that over-the-counter omeprazole, one of the most popular PPIs, should only be taken for 14 months. to dawn.

It adds: ‘If you don’t feel better after 14 days, tell your doctor, who may want to do further tests or change your medicine.’

But some British experts argue that the benefits of PPI far outweigh any potential disadvantages.

‘They are very good medicines and for the vast majority they work well with lifestyle changes,’ says Paul Goldsmith, consultant surgeon at Manchester University NHS Foundation Trust.

And Tim Underwood, professor of gastrointestinal surgery at the University of Southampton, says: ‘The link between PPIs and conditions such as Alzheimer’s is overstated. Millions of people have been using PPIs for years and they are doing fine.’

When Bradley, a fit 6-foot-2 man who has never been overweight, developed reflux, the cause was a mystery.

By the time he ate that chicken and mash meal 18 months ago, his restricted lifestyle meant his weight had dropped to less than 11st. The reflux had also caused him to develop a hiatal hernia due to a weakening of the esophageal sphincter, the muscle ring that holds food in the stomach.

A keen cook, he and Barbara chose a house near Leicester’s golden mile of curry houses when they moved from Kent nine years ago to be near their daughter Sarah, 41, and grandchildren Annabelle, 11, and Myles, eight .

Bradley even took an Indian cooking course to improve his repertoire of spicy dishes.

‘But that all had to stop because I just couldn’t eat curry anymore. I tried all the different PPIs for about five years, but they never really made much of an improvement.”

The most important surgery for reflux disease is an operation called fundoplication, in which the bottom of the esophagus is wrapped around the opening to the stomach to form a valve.

A newer procedure, the Linx operation, was introduced in 2012. This involves placing a ring of interconnected beads, each with a weak magnetic force that holds the beads together, at the bottom of the esophagus through keyhole surgery. When the person swallows, the magnetic force is overcome and the ring can open. Magnetic attraction then brings the beads back together and the esophagus closes, preventing stomach acid from leaking back into it.

However, these procedures can fail if the patient gains weight, which increases pressure on the stomach. Patients are no longer able to vomit or belch, which can cause pain.

Bradley is one of 25 people in Britain to undergo a new approach using a device called RefluxStop.

Surgeons create a small pouch at the junction where the esophagus meets the stomach and insert a ceramic ball, half a centimeter in diameter, into it, which acts as a one-way valve. It allows food to pass through, but nothing more can come up.

Bradley says: ‘I hadn’t had a curry for about five years, but I had my first one within five days of the operation and within a week I was back to a completely normal diet.’

Nick Boyle, a senior specialist reflux surgeon operating in the private sector in London and employed by the device manufacturer, performed Bradley’s operation, which cost £15,000.

But not all surgeons think there is enough evidence to support its use.

Professor Underwood said: ‘There is no data on the success of RefluxStop and people should not have the device inserted outside of a clinical trial. There are also no data on whether the Linx procedure is better than fundoplication.

‘We are about to embark on the first project to answer this question with a study of 460 people randomly assigned to each of the different treatments, but it will take three to five years before results emerge.’

Consultant general surgeon Paul Goldsmith adds: ‘There are some patients who could benefit from surgery, but it is a very small percentage of the total number.’