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10 Month Follow Up

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  • 10 Month Follow Up

    Went to see my Stretta Dr's PA today for my 10 month follow up. Not a lot new. I've been feeling well, either symptom free, or only minor symptoms now for the past 4 months. I am now on 2 prilosec OTC per day and one pepcid. While this may seem like a lot of meds, last year at this time I was taking 2 nexium and 2 pepcid per day, plus extra antacids frequently, and it felt a lot of times like things were just getting worse all the time. I switched from nexium to prilosec otc about 3 months ago, but have not been anxious to reduce my dosage since I would rather over medicate than under control my symptoms. (My experiences in the past when my symptoms were out of control were so bad, I'll do just about anything to avoid that again.)

    As a bit of an aside, I have never been charged for the procedure, and it appears they never submitted anything to my insurance company. I have called the Drs office several times and talked to them about it today, but don't have anything defnitive on the cost. So I don't know what the final cost will end up being.


  • #2

    Hi Randy Glad that you are feeling better . Any improvement is good . It's hard to tell yet just how much can be attributed to the Stretta because of the episodic nature of GERD.

    How long did they say it would take before you felt the maximum benifits ? Is it supposed to be immediate , or does it take time ? I forget . Thanks for posting and keeping people updated on your progress, it's really interesting, as well as helpful. ........ Boy it sure takes a long time for them to bill you. All of my bills come way too quick

    Merry Christmas to you ,and wishing you a very healthy and Happy New Year


    • #3
      wow - forgot to bill you!

      My little Stretta experiment at Mayo cost me a whopping $6K out of pocket. Sure wish it had lasted a bit longer. Sounds like it really helped you, Randy. It's been long enough, you should be able to tell. That is such good news.

      Tricia - they told me the ablations' effect kicks in within 3 months and hypothetically just improves from there. I was almost PPI free for 18 mos. Then, it all came roaring back. It does work for some people though, that's why they keep doing it, and the asthma related to GERD is MUCH better since the procedure. That was almost worth the cost of the surgery - almost!

      All the continued success, Randy!!!!


      • #4
        I did make a little progress on the billing front. It looks like the cost to me will be around $2500. I have a very large deductable, but my ins. company usally only allows about half the charges rendered, otherwise total would have been around 5,000.

        I was told it would be 3-6 months before the treatment became effective, which seems about right. I suspect my problems earlier were when it was just too early. Then again, giving up any kind of dairy products and a few other things I thought were ok may have done it all. But even if that's so, then the procedure saved my from a fundo, which was my next step otherwise. When all is said and done, I'm feeling good and not going to spend much time analyzing it.



        • #5
          A silly question. I read on the reflux one website, that Dr. Noar is claiming 100% success with the stretta for patients that have had failed fundoplications (at least that is how I read it). Now does the stretta thicken anything up, or does it make the muscle contract, or does it just numb the sensation. If it makes the muscle contract more, how does that work in the case of a fundoplication?

          Randy -- thanks so much for keeping in touch with us and letting us know how you are. I do remember a doc (Noar?) saying that he sometimes he has to go back in and do the stretta again for maximum results. Diane - did your doc say anything like that? Anyway, Randy, that might be a help to well as taking lots of B vitamins and drinking lots of water (if you can tolerate it).

          Merry Christmas everybody.......and Happy Holidays. b


          • #6
            Can't afford to have stretta done again

            I can't afford to have the stretta done again. The procedure is not covered at all by my insurance and I payed $6K out of pocket last time. Can't afford that again. The doc also said that because my stretta didn't last, he didn't know if doing it again would really help me (this from a guy at Mayo who helped pioneer it). He recommended fundo which I will not do under any there you are! I know stretta is still not done too much.....


            • #7

              Diane...I don't understand this statement..." He recommended fundo which I will not do under any there you are! I know stretta is still not done too much.....". From what I have read, the nissen has a higher success rate than the stretta. The stretta has a 75-80% success rate vs the nissen which has a 90%.


              • #8
                Dont' have a year to recover if it's not a good result

                I know two people who were about debilitated by fundos - one was my brother. He had a top notch surgeon, too. I don't have a year to recover if I'm one of the unlucky ones who has problems. Stretta had virtually no down time - only reason I did it. So, that's why.


                • #9
                  Thanks Dianne and Randy, was wondering how long the doctor said it took to work .

                  Buffy There seems to be almost a general consensus now that the main mechanism of action against GERD regarding the Stretta appears to be ( from the latest few studies ) that the scarring toughens and desensitizes the esophageal body from feeling symptoms ......which is disappointing .


                  • #10
                    I think their are two mechanisms. First, is the scarring which thickens the LES, producing less reflux. Second, the nerve impact, however, the main effect seems to be that it produces a reduction in TLESRs (transient relaxations of the LES) which play a big role in reflux. The "deadening the nerve" theory, has never been proven to my knowledge. (In my own case, I felt more sensitive to reflux the first few months, if anything.) However, when all is said and done, the ultimate mechanisms of action are not known. I suppose I should eventually have follow up endoscopy to see if I am getting any damage from acid exposure.



                    • #11

                      Hi Randy Yes the theory is that it may interrupt the afferent nerves that control transient relaxations of the LES

                      But because of results of some studies showing no significant decrease in esophageal acid exposure, it is hypothesized that the possible mechanism of action is neurolyis resulting in decreased esophageal sensitivity to acid exposure.............. rather than any reduction in acid exposure itself.

                      Regardless, whoever is right.... it does greatly improve quality of life and i think it has an important place. Not for severe GERD though , ( some developed esophagitis in studies) but none of these endoscopic procedures are meant for severe GERD . They are meant more to reduce meds and improve quality of life.


                      Corley DA; KatzP; Wo JM; Stefan A; Patti M; RothsteinR; Edmundowicz S; KlineM; MasonR; WolfeMM

                      BACKGROUND & AIMS: Gastroesophageal reflux disease is a prevalent disorder that often requires long-term medical therapy or surgery.

                      METHODS: We randomly assigned 64 gastroesophageal reflux disease patients to radiofrequency energy delivery to the gastroesophageal junction (35 patients) or to a sham procedure (29 patients). Principal outcomes were reflux symptoms and quality of life. Secondary outcomes were medication use and esophageal acid exposure. After 6 months, interested sham patients crossed over to active treatment.

                      RESULTS: At 6 months, active treatment significantly and substantially improved patients' heartburn symptoms and quality of life. More active vs. sham patients were without daily heartburn symptoms [61%] vs. [33%]; , and more had a >50% improvement in their gastroesophageal reflux disease quality of life score [61%] vs. [30%]; Symptom improvements persisted at 12 months after treatment. At 6 months, there were no differences in daily medication use after a medication withdrawal protocol [55%] vs [61%]; or in esophageal acid exposure times. There were no perforations or deaths.

                      CONCLUSIONS: Radiofrequency energy delivery significantly improved gastroesophageal reflux disease symptoms and quality of life compared with a sham procedure, but it did not decrease esophageal acid exposure or medication use at 6 months. This procedure represents a new option for selected symptomatic gastroesophageal reflux disease patients who are intolerant of, or desire an alternative to, traditional medical therapies.


                      • #12

                        Thanks for your comments. This is certainly one of the areas of controversy surrounding the proceedure, which I learned early on. I found a brochure on Stretta at my GI doc's office. I asked him about it, and he was very discouraging. He said his theory was that it just deadened the nerves, and could lead to really bad outcomes. He was much more positive on the fundo procedure. I almost did the fundo, but various things delayed it (including my doc never giving me the results of my manometry, but that's another story), and I read a lot of "internet horror stories" about it, here and on other boards. I only have a few week window of opportunity during the year when I coudl do it, which I missed, so I was going to wait till the next year.

                        However, I decided to look into stretta further, since I could not figure out why some Drs in the practice I went to provided the procedure, while my doc was very negative about it. I read just about every article and study I could get my hands on (I got the artice you referenced above directly from Corley, along with an editorial about the procedure in the Gastro Journal. I also got Wolfsen's article from the author as well.) I went to the FDA site and read every report concerning problems with the Stretta device as well. (The scariest one was a case where the device seemed to get stuck, though they got it out w/o problems). I finally bought an article examining the nerve deadening issue (abstract below).

                        Basically, the problem with Stretta is that a substantial percentage of patients do not benefit from it. For those "non-repsonders" acid exposure, ppi usage, etc is not improved. This ruins the averages when compared to the sham group. However, responders (those whose symptoms improve) were shown to have reduced acid exposure, so I was satisfied. Also, since my EGDs never showed any erosions or visible signs of esophagitis (on biopsy only) I figured that perhaps the problem was an overly sensitive esophagus. I may also do a follow up EGD to see that no undetected damage is occurring.

                        In the end, I went to see the head of the practice, and he was convinced of the benefits of stretta, and I decided to go with it. (He was much more experienced than my first doc and participated in clinical trials of the procedure.) However, I would not recommend that anyone else do the procedure unless they really became informed enough to understand the issues and make an informed decision.

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

                        G. Triadalopoulos Gastroenterology Section, Veterans A.airs 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 Received: 22 January 2004/Accepted: 15 February 2004/Online publication: 27 May 2004
                        Abstract Background: Endoscopic radiofrequency energy delivery (Stretta) is e.ective for managing gastroesophageal re-flux 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. to a decrease in esophageal acid exposure and not to desensitization of the esophagus.

                        In conclusion, Stretta relieves GERD symptoms, improves patient satisfaction, and decreases daily PPI use through a decrease in both proximal and distal acid exposure times, and not by desensitization of the esophageal body."



                        • #13
                          Wow, a real debate

                          Well, regarding that conclusion from Stanford University School of Medicine... what is it based on? Symptom relief and observation OR (and this would make it more believable to me) a 24 hour pH probe follow up? As I understand it the only thing that comes close to definitive to measuring of acid exposure is the probe. Was that part of the Stretta study? I just ask because I tend to side with Tricia on this.

                          Mind you, many of medicine's most common treatments involve pallitive measures only (nerve blocks, stents, etc...) not "cures." And this is fine (as I've recently found a fantastic resource on LPR which indicates that, like GERD, it can be asymptomatic) because it is the symptoms that drive ya crazy.

                          So, notwithstanding your research, I'm still a bit skeptical but am definitely open to learning what they base their conclusion on. Test or observation? Inquiring minds want to know.


                          • #14

                            The actuality of this is despite these studies it's early to determine the effacacy of Stretta. Time will tell. The effects were not permanent in my case, but my doctor at Mayo said that he had folks that still experienced relief up to two years later (not much later data than that). Now whether some of it is placebo effect, I don't know, but Dr. Fleischer did say that plays into the mix.

                            I had a recent EGD and my espohagus looked good and was normal in biopsy, although I had a transient relaxation during the procedure. The scarring from the Stretta was barely evident to the doc.

                            SO - I think docs must persevere with these new treatments. As we know from this board, although Nissen is 'successful' for many patients - there is often a symptom trade-off and the procedure is no walk in the park, sometimes with an arduous recovery period.

                            There WILL be an endoscopic alternative to Nissen, it's just a matter of time. In the mean time unless some of us stay open to new procedures we'll never know if they help or not.


                            • #15

                              They did 24 hour ph tests with stretta patients before and after the procedure. Typcially something like 2/3-3/4 of the stretta group got better while 1/4 - 1/3 did not. They found that the "responders", those that got better did have better ph numbers, while non responders did not. The interpretation was that while not everyone benefits from the procedure, those that do did so because they had improvements in acid exposure, not simply from deadening of nerves. This alleviates the fear that patients will continue to have their disease progress and do them damage, while not knowing its happening.

                              Of course, this was an after the fact statistical analysis, but it was statistically significant. I would put in the whole article, but I think its copywright protected.

                              In any case, it pays to be skeptical about all of this stuff. All things considered, I think the biggest drawback of stretta is not so much the possibility of being unaware of ongoing damage to the esophagus, but rather that it may not be effective, and/or that the benefit may not last (as in DianeS' case.) The problem of damage to the esophagus can easily be avoided by simply continuing PPI therapy, for example. In my case, I never had any real damage, but had lots of pain even on 2ppis and 2 h2s per day.

                              When all is said and done, all therapies have drawbacks - they either don't work, cost too much or produce unwanted side effects. A quick review of this forum shows ample evidence of people for whom stretta, fundo's, ppis etc don't work, produce adverse side effects, etc. You have to choose your poison, or is it chose your cure. At this point, I'm happy with my choice. I don't know if that will be true in 6 months or a year from now.