Chicken, peas and mashed potatoes may seem like a pretty ordinary meal to most people, but for Bradley Phelps, that dinner after an operation he had at a private hospital in March 2022 was the first normal meal he was able to eat. in five years.
“It was incredible,” he says. ‘I didn’t feel the pain, nausea or acid returning to my mouth like I did before with normal meals. I couldn’t believe it.’
On 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 disease 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 from long-term use of over-the-counter proton pump inhibitor (PPI) medications to treat it, there is likely to be a growing clamor. for such surgery.
“I had been getting sicker and sicker for about 15 years and, for the previous five, I had been subsisting on dry toast for breakfast and a sandwich for tea,” says Bradley, 71, a retired gardener who He lives in Leicester with his wife Barbara, 69.
With more and more people developing reflux due to obesity and lack of exercise, and concerns about the health risks from long-term use of over-the-counter proton pump inhibitor (PPI) medications to treat it, there is likely to be a growing clamor. for such surgery
I had first developed GERD when I was around 50 years old. At the time of surgery, he says, eating anything but a small amount of bland food was unbearable.
“The pain in my throat was with me 24 hours a day and my chest felt like it had an elastic band around it.”
Bradley is among one in four people in Britain who, according to the charity Heartburn Cancer UK, have been recommended PPIs, one of the world’s most widely used medications for acid reflux. This is where stomach contents painfully bubble back up into the esophagus, the tube that carries food from the throat to the stomach.
While some people are predisposed to GERD as they age, obesity is the main factor behind the increase in cases.
Given that around 70 percent of men and 60 percent of women are overweight or obese, these figures could help explain why more men than women are affected.
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 make it difficult to swallow food.
Exposure to stomach acid can also cause Barrett’s esophagus, a growth of abnormal cells that causes pain, difficulty swallowing, a feeling of food stuck in the throat, an unpleasant taste in the mouth, and bad breath.
This abnormal cell growth can, in turn, cause cancer. Cancer Research UK says rates of oesophageal cancer have increased by 40 per cent since the early 1970s, with the disease claiming 8,000 people a year in the UK.
However, there is growing evidence linking PPIs (the same medications that can reduce reflux) with long-term harm.
In a recent study, researchers from six US universities analyzed data from more than 5,700 people from the late 1980s onward and found that taking PPIs for more than 4.4 years was linked to a higher incidence of dementia. in people over 45 years of age, the magazine reported. Neurology in August.
“PPIs are thought to affect amyloid beta, a type of protein,” explains Chris Sutton, clinical director of upper gastrointestinal surgery at Leicester Royal Infirmary.
‘Amyloid beta accumulation is associated with dementia. There is a natural enzyme in the brain called V-ATPase that removes amyloid beta, but PPIs interfere with the production of that enzyme.’
Other studies have suggested that PPIs may reduce the absorption of dietary vitamins and minerals, which has been linked to the development of osteoporosis, as well as allowing the growth of harmful bacteria in the digestive system that would normally be eliminated by dietary acid. stomach.
“PPIs work by blocking acid production in the stomach,” says Mr Sutton.
‘The natural production of stomach acid kills bacteria. If the amount of acid in the stomach is reduced, people are at greater risk of food poisoning or Clostridium difficile infection (a potentially serious infection).’
PPIs have been available without a prescription since 2015. It is feared that many patients take them for years, although the NHS website says, for example, that over-the-counter omeprazole, one of the most popular PPIs, should only be taken for 14 days .
He adds: “If you don’t feel better after 14 days, tell your doctor, who may want to do more tests or change your medication.”
But some UK experts insist that the benefits of PPI far outweigh any harm.
“They are very good medicines and for the vast majority they work well along with lifestyle changes,” says Paul Goldsmith, consultant surgeon at Manchester University NHS Foundation Trust.
Reflux triggers include spicy foods, citrus fruits, and caffeine, which can irritate the valve between the stomach and esophagus.
And Tim Underwood, professor of gastrointestinal surgery at the University of Southampton, says: ‘The link between PPIs and diseases such as Alzheimer’s has been exaggerated. Millions of people have been taking PPIs for many years and are doing well.’
When Bradley, a fit six-foot man who has never been overweight, developed reflux, the cause was a mystery.
When he ate chicken and mash 18 months ago, his restricted lifestyle meant his weight had dropped to less than 11. The reflux had also left him with a hiatal hernia as a result of a weakening of the osophageal sphincter, the ring of muscle that keeps food in the stomach.
A keen cook, he and Barbara chose a house near Leicester’s Golden Mile curry houses when they moved from Kent nine years ago to be near their daughter Sarah, 41, and grandchildren Annabelle, 11 years old and Myles, eight.
Bradley even took an Indian cooking course to improve his repertoire of spicy dishes.
“But all that had to stop because I couldn’t eat curry anymore.” I tried all the different PPIs for about five years, but they never really got much better.’
The main surgery for reflux disease is an operation called fundoplication, which involves wrapping the lower part of the esophagus around the opening of the stomach to form a valve.
A newer procedure, the Linx operation, was introduced in 2012. Here, a ring of interconnected beads, each with a weak magnetic force that holds them together, is placed in the lower part of the esophagus using keyhole surgery. When the person swallows, the magnetic force is overcome and allows the ring to open. The magnetic attraction then brings the beads back together and the esophagus closes, preventing stomach acid from re-entering.
However, these procedures can fail if the patient gains weight, which increases pressure on the stomach. Patients may be unable to vomit or belch, which can cause pain.
Bradley is one of 25 people in the UK who underwent a new approach, using a device called RefluxStop.
Surgeons make a small pocket at the junction where the esophagus joins the stomach and insert a ball (made of medical-grade silicone), half an inch in diameter, which acts as a one-way valve. It allows food to pass through, but nothing can come back up.
Bradley says: “I hadn’t had curry for about five years, but I had my first one five days after the operation and within a week I was back to a completely normal diet.”
Nick Boyle, a reflux surgeon operating privately in London, carried out Bradley’s operation, which cost £15,000. Mr. Boyle’s clinic website states that the new device “is generating excitement among doctors and patients alike.”
But not all surgeons believe there is enough evidence to support its use.
Professor Underwood says: ‘There is no data on the success of RefluxStop and people should not insert the device outside of a clinical trial. There is 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 that will involve 460 people who will be randomly assigned to each of the different treatments, but it will take between three and five years to obtain results.”
Consultant general surgeon Paul Goldsmith adds: “There are some patients who may benefit from surgery, but it is a very small percentage of the total number.”
- This article was first published in September 2023.