10 Month Follow Up

[tricia]

Stretta

Hi NBrazil Here is a more detailed description of the study Randy posted ..They don't go into the methods in great detail . [url]http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&li st_uids=15156392&query_hl=5&itool=pubmed_DocSum [/url]

They took an old study and reanalyased it using Pearson's Correlation Coefficient[url]http://www.vias.org/tmdatanaleng/cc_corr_coeff.html[/url]

Hi Randy I'm familiar with Dr. Triadafilopoulos and his Stretta studies ,including the one you posted . He has many published studies on the Stretta.... all very positive . I'm familiar with the responder and non responder theory you were talking about too---- and Triadafilopoulos talks about this in a lot in his articles. But is it just something they came up with to try and explain away why so many people in these other Stretta studies had no decrease in acid exposure ?

The problem that i have with Dr Triadafilopoulos, is he has a vested interest in Curon Medical and is a paid researcher . His disclosure says this............

Dr. Triadafilopoulos is a consultant to almost all the major pharmaceutical companies that are active in the area of gastroesophageal reflux. He has received funding for studies, seminars, and travel from such companies and also has an equity position in Curon Medical, Inc.( Stretta)

I have a problem beleiving that someone who has investment in a product can conduct unbiased studies on it .... but maybe so . Plus .... Can't help but wonder what perks he gets. : Look at all of the favourable studies on the other endoscopic procedures... very misleading, and contradictory . Many of the fundo studies are misleading too, but that is another egg to fry on another day. There are a lot of politics involved in studies. ........
.
GERD is a hard thing to study anyway because of it's episodic nature. You can have totally normal reflux days and acid exposure varies day to day. By the way even though some subjects had a decrease in acid exposure ... it was still at abnormal levels in some of them ... just decreased some.

Anyway i am not knocking the Stretta ... was just saying what the talk was, Whatever the mechanism ... i don't know , but it may be a good option for those with non erosive disease .....i think... Way more attractive to me than a fundo . Take Care

[Randy]

Tricia,

I was aware of Dr. T's "vested interest." He's certainly the most vocal proponent of stretta. So does he really beleive in it, or perhaps he's not objective? Impossible to say. It seems that many of the various studies in the endoscopic procedures were performed by peeps with some financial interest in the outcome. (When I checked out Enteryx, the Doc I saw mentioned that was problem with Enteryx as well.) So far as I know, the Corley study was not only the most rigorous, but I am not aware of any vested interest in that case. (However, I suspect the study was probably funded by Curon, so there you go.)

In the financial world this kind of thing has recieved a lot of publicity, and we now have "full disclosure" requirements. In the medical field we're a long way from that. However, it does seem to permeate the entire field. I always get a chuckle when I go the GI Doc's office. Its filled with clocks, knick knacks, pens and pencils, note pads, decorations, wall charts, etc - all from PPI makers.

BTW - I found a really interesting article on Prilosec vs. Nexium, I'll try to post in another thread - I'd be interested in your insights on it.

Randy

[missJ]

Many of the fundo studies are misleading too, but that is another egg to fry on another day. There are a lot of politics involved in studies. ........
.

Tricia, what you wrote is very intriguing. Can you eluminate further??

[tricia]

Hi Randy I'll see if i can find that study

Hi Jen I was referring to the varibility of fundo studies and how they can be confusing . The success rates range from 70 to 90 percent, depending on who is behind the study.

Surgeons often quote that 90 percent success rate , but don't explain that a 90 percent success doesn't mean a total resolution of symptoms. That is not how success is measured in a study .

Also fundo studies are usually done in major academic centers with small numbers of people by high profile surgeons with vast experience , using the perfect surgery candidates . There are many incompetant fundo surgeons out there and these studies don't reflect any of that aspect.

The side effect rates vary depending what study you are reading. Very recently, several new studies have come out saying that side affect rates for fundiplication surgery are shown to be as high as 40-50 percent. But there are also studies circulating around saying side effects are as low as 5 percent. There is growing contoversy over the durability of the procedure too, with totally conflicting studies on how long the fundo actually lasts .

There are studies out there like Vazi et al for example, showing that 60 percent of people will still need PPIS after surgery ( even though 30 percent of these people have negative ph tests ) There are also seperate studies by Vakil , Klaus, and Spechler with similar findings that a very high number of people will still need PPIS despite surgery

And there are studies out there with the very opposite findings. It's hard to sort it all out as to which studies you should gauge by.