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Russell Theobald was diagnosed with gastro-oesophageal reflux disease at 21
Millions of Britons suffer from heartburn caused by acid reflux. A new study has shown that a magnetic implant can help. Police officer Russell Theobald, 39, had the procedure, as he tells JENNIE AGG.
THE PATIENT
Out with some friends one night, I got a sudden attack of heartburn, so intense it made me sick. I was only 21, and to me heartburn was something my gran suffered from.But over the next year I'd get a painful burning feeling in my chest whenever I ate, and sometimes a sour taste in my mouth. I cut out bread, white flour and pastry - which gave me heartburn instantly - but it always came back.
I saw my GP, who diagnosed gastro-oesophageal reflux disease (GORD). This is chronic acid reflux, where stomach acid spills back up into the gullet, or oesophagus, irritating its surface and causing the burning feeling. I took antacids, which neutralise the acid, and later proton-pump inhibitors (PPIs), which reduce the amount produced.
These were brilliant for 15 years. Then suddenly, in 2011, my medication stopped working, for no clear reason.
By now, the heartburn was near constant, so I was referred to an upper gastro-intestinal consultant. I had a gastroscopy, where they put a camera down the oesophagus to see what's going on. It revealed I had a weak sphincter muscle between the oesophagus and the stomach. This would usually close to stop anything moving back up.
The consultant also said I had Barrett's oesophagus - an area of cells in my oesophagus had been damaged by constant acid exposure. This condition is linked to oesophageal cancer, as the damaged cells can mutate, which was frightening.
I would need a gastroscopy every two years, to check the area of damaged cells hadn't grown.
I'd been offered the traditional surgery for acid reflux on the NHS before, which involves looping the top part of the stomach around the weak muscle to help it stay closed.
But it means cutting part of the stomach. And it's irreversible - long-term side-effects can include difficulty swallowing and painful bloating. I was only 37, with a young family, and such a drastic-sounding op seemed too risky.
So I researched other treatments - and I remembered an article my mum had sent me about an implant that uses a ring of tiny magnetic beads, like a necklace, to pull the oesophagus closed.
I found a few surgeons doing it in London, one of whom was Mr Hashemi at the private Weymouth Hospital. He told me I could be considered for the op.
The implant uses a ring of tiny magnetic beads, like a necklace, to pull the oesophagus closed
I had to have several tests, including 24-hour monitoring of the level of acid in my oesophagus, and went in for the op in last December - finally, after 18 years, there was light at the end of the tunnel.
Although the op itself takes just 40 minutes, the recovery isn't easy. In my first week I had pain in my jaw and chest. And nine days after surgery swallowing became painful because of the scar tissue that starts forming around the device. It got so bad I couldn't eat any solids, only meal replacement shakes. But, as Mr Hashemi had assured me it would, it eased up 18 days after surgery.
About six weeks later, I got a sharp, gnawing pain in my chest. This was caused by the oesophagus spasming - I was given anti-spasmodic medication and painkillers and assured it was the body getting used to the device.
Four months on from the operation, I'm basically back to normal. I still have to be careful about chewing food properly, and will need a gastroscopy every few years to check on my Barrett's oesophagus. But I haven't had a single episode of heartburn.
It's made such a difference. I'm no longer taking tablets. I've been able to eat all my trigger foods - the only thing I have to worry about now is my weight.
THE SURGEON
Majid Hashemi is a consultant gastro-intestinal surgeon at the University College London Hospital and the Weymouth Hospital.Most of us experience heartburn from time to time. We have a muscle, the lower oesophageal sphincter, that acts like a valve between the oesophagus and stomach.
Normally, it opens to let food into the stomach, but stays closed while you're digesting food to stop anything moving back up. Occasionally some acid spills out - causing the burning feeling we know as heartburn.
'Although over-the-counter antacids treat heartburn, your oesophagus is still being exposed to acid. The best way to stop acid escaping is with a mechanical barrier'
For many people, heartburn improves with lifestyle changes - being overweight can make it worse. Hernias can also press against the sphincter, stopping it working properly. However, for many people, it can just happen. If left untreated it can cause all sorts of problems including difficulty swallowing, inflammation and Barrett's oesophagus - which leads to cancer in one in 100 people. It can also cause recurrent asthma and pneumonia as fluid can also reach the throat and lungs.
Most people rely on over-the-counter antacids for years. However, although these treat the heartburn, your oesophagus is still being exposed to acid. The best way to stop acid escaping is with a mechanical barrier. However, the traditional surgery offered can seem daunting - even though it is a well-established, safe technique.
The main problem is the procedure - known as Nissen fundoplication - to loop part of the stomach around the lower oesophageal sphincter is a permanent change to your stomach, a potential problem if people experience side-effects.
But now we can do an alternative operation to fit an implant known as the LINX system, developed in the U.S. almost a decade ago and used here for three years. There have now been 1,000 operations to insert this device, and a new study at the University of Southern California has concluded it is a safe procedure.
The system uses a small magnetic implant, about 4.5 cm to 5 cm long, which forms a ring the size of 50p coin around the oesophagus. It's made up of tiny 4 mm magnetic beads, coated in titanium. The beads are linked by tiny individual wires, which makes it very flexible.
For many people, heartburn improves with lifestyle changes - being overweight can make it worse
The string of beads wraps around the lower oesophageal sphincter muscle to support it. The beads can be forced apart by food and drink as it's swallowed, but once it's through, the magnets pull together again to keep the sphincter closed.
Fitting the implant takes 40 minutes, half the time of the fundoplication procedure. Patients can eat and drink much sooner afterwards and normally go home the next day.
We make four little cuts, three 5 mm and one 10 mm incision, just below the breast bone, to create a window around the oesophagus.
We then measure the circumference of the oesophagus in millimetres using a custom-built device that curls around it. We can then vary the number of magnetic beads we use accordingly. This precision is a big part of why LINX works so well.
In gastric reflux surgery, if the support to the sphincter is too tight it is hard to swallow, and if it is too loose acid continues to splash up the oesophagus. With LINX, patients may have trouble swallowing as scar tissue forms, but this gets better with time - it's important for patients to eat regularly to keep the oesophagus working.
'We don't know if fitting the device could lead to a build-up of scarring in the long term (which could cause swallowing problems), as this can take years to form'
We insert the string of beads into the abdomen through a fine tube in the largest incision, then we wrap the length of beads around the oesophagus and fix the two ends in place at the front with a clasp. It is much simpler than fundoplication, as the only thing that varies is the measurement of the oesophagus. According to the recent U.S. study, complications arise in only 0.1 per cent of cases - these typically include problems swallowing, needing the device removed or extra surgery to adjust it.
If it becomes available across the NHS - it is already at the Royal Devon & Exeter NHS Foundation Trust and at Epsom Hospital, Surrey - it could help thousands who don't want an irreversible procedure. The LINX device can be removed if there are problems, but it is designed to last for life.
It's not suitable for very obese people and anyone who's had previous surgery on the lower oesophageal sphincter.
Fitting more patients with the device could save money because it will save on surgery time, and could spare more people the serious long-term complications of damage caused by chronic reflux.
ANY DRAWBACKS?
'This is a simpler, quicker operation. However, it's still new and we don't yet have the long-term data to see how it compares with other techniques,' says Dr Anton Emmanuel, consultant gastroenterologist at University College Hospital.'We don't know if fitting the device could lead to a build-up of scarring in the long term (which could cause swallowing problems), as this can take years to form.
'It is also not suitable for everyone with a hiatus hernia, and for many patients with chronic gastric reflux this will be the cause.'
To have the device fitted privately will cost £8,000 to £8,500. It will cost a similar amount to the NHS.
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