How a blast of hot gas fired down the oesophagus could ease the agony of heartburn

By Liam On Mar 20, 2023

A blast of hot gas can relieve the pain of heartburn.

Argon gas is fired from a thin tube that is inserted deep into the esophagus (oesophagus) while the patient is sedated.

It targets an area around the valve where food passes from the esophagus to the stomach. This is where stomach acid often leaks back into the esophagus, causing pain.

The heat from the gas “cooks” the top layer of tissue in the esophagus, causing it to contract and shrink – causing the esophagus to narrow in that area.

This reduces the space available for acid to seep through the valve, relieving the burning sensation.

Treatment focuses on the area where stomach acid often leaks back into the esophagus and causes pain

Argon gas is fired from a thin tube that is inserted deep into the esophagus while the patient is anesthetized

A clinical trial testing the new approach is underway in Germany, involving 15 patients with severe heartburn.

Heartburn affects about one in three people at some point in their lives. It is caused by hydrochloric acid – which is produced in the stomach to break down food – flowing back into the esophagus and causing pain.

This happens when there is a fault in a valve called the lower esophageal sphincter, which controls the flow of food into the stomach and prevents the acid from going the other way.

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Occasional heartburn can be treated with over-the-counter antacids, which dampen the inflammation in the esophagus caused by leaking fluids.

But an estimated eight million people in the UK suffer from chronic acid reflux – known as gastroesophageal reflux disease (GORD) – in which the lining of the esophagus becomes damaged from overexposure to acid.

Risk factors include pregnancy and obesity — both of which increase pressure on the stomach — and certain medications (such as some high blood pressure pills or antidepressants), which irritate and weaken the valve.

Most those affected will benefit from drugs called proton pump inhibitors (PPIs), which lower acid production. But some patients need a surgical procedure called fundoplication, which sews the upper part of the stomach around the esophagus to support the valve.

While generally successful, the procedure can cause problems such as burping, vomiting, or pain when swallowing.

Now doctors at the Garmisch-Partenkirchen Clinic in Germany are testing argon gas therapy as a possible alternative to surgery.

The technique, called argon plasma coagulation, is already widely used in some types of gastric surgery as a way to control bleeding.

A thin probe called a gastroscope is passed through the mouth and into the stomach. At the push of a button, argon gas is blasted from the tip in a bright energy beam that cauterizes damaged blood vessels, causing bleeding.

In heartburn, the theory is that the same approach burns the tissue around the lower esophageal sphincter, shrinking it enough and stopping acid from leaking upward, without making it harder for food to move down.

Similar techniques are widely used throughout medicine to burn tissue in this way. A case report of a patient who received the argon gas treatment – published in the American Journal of Gastroenterology in October 2021 – said heartburn symptoms virtually disappeared within a few months of the procedure.

The patients in the trial each have an area of tissue no larger than 2 cm irradiated with the gas and kept in the hospital for 48 hours before being discharged. Regular checkups will determine how successful the procedure is.

Commenting on the approach, Laurence Lovat, professor of gastroenterology at University College London, said: ‘The procedure is very simple and in theory it could work.

“It’s worth doing a little trial first, but there are a lot of new procedures for acid reflux that have fallen by the wayside.”

Those who suffer from atopic dermatitis are more at risk of developing acid reflux

People with the skin condition atopic dermatitis are more at risk for acid reflux, reports a study from Korea University in Sejong, South Korea.

Research based on more than 9,000 adults with the skin condition found that they were 15 percent more likely to experience severe heartburn than others without dermatitis, the journal PLOS One reported.

One theory is that atopic dermatitis increases levels of a substance called histamine, which is involved in allergic reactions; some research suggests that high histamine levels weaken the muscles that control the valve between the esophagus and stomach.