For an area of tissue only a few squares inches in size, the physiologic sphincter where the human esophagus joins the stomach can cause a lot of problems. There's nothing to distinguish the spot visually from the rest of the esophagus except a mild thickening of the muscle, according to surgeon Scott Pennington, MD of Advanced Surgeons PC in Birmingham. But pressure monitors can detect the action of a valve there - one with the crucial function of preventing food, saliva, and the stomach's digestive acids from moving upwards toward the throat.
When the valve malfunctions, as it does for some 20 million people in the U.S. each year, the result is the chronic heartburn of gastro-esophageal reflux disease (GERD), which Pennington says is the most common significant gastrointestinal problem.
"That's usually the culprit in folks who have acid reflux," Pennington says. "There's low pressure there, so that when the stomach releases acids they tend to leap back into the esophagus."
If acid-reducing medicines such as Prilosec and Nexium don't relieve the symptoms, another option is surgery. The traditional repair method, a Nissen fundoplication, named for the Swiss surgeon who first performed it in 1955, wraps a portion of the upper stomach around the faulty valve to reinforce its ability to close.
The main drawback to such a procedure is that it's not releasable, and afterward patients can have trouble belching and vomiting.
But a new technological breakthrough takes an inventive approach to solving that problem. It is an implantable device that resembles a small necklace, a circle of tiny magnets connected by titanium wire. The magnets' mutual attraction imitates the flexible squeezing action of the natural sphincter. According to Pennington, the normal pressure of digestion is able to temporarily overcome the attraction of the magnets, and as the bolus of food passes, the magnets re-attract.
Known as the LINX Reflux Management System, the minimally invasive device is implanted by laparoscopic surgery. "Right now," Pennington says, "we're keeping patients overnight until we get more information, but essentially it's an outpatient procedure."
The public awareness of GERD has increased significantly in recent years, he says, partly because of widespread advertising of the pharmaceutical products that combat it. "We're also better at detecting it, and it's well communicated to the lay public that treatments are there.
"There's a large portion of the population whose symptoms are sort of in-between. They don't have severe, debilitating reflux that makes them sick every day. But the symptoms occur most days, and until now there hasn't been a really good treatment for them except medication."
But the condition is apparently on the rise as well, Pennington says, for a number of reasons.
Obesity, which is a major predisposition to GERD, is on the increase. Americans also tend to eat more food per meal than previously, and the content of our diets now includes more high fats, caffeinated and carbonated beverages, and alcohol. "When you add all those factors up for the average person," says Pennington, "it's probably safe to say that the condition is more prevalent than it was a generation ago."
Pennington is one of five doctors practicing at Advanced Surgeons, located on the campus of Trinity Medical Center, who perform surgical oncology as well as colon, rectal, endocrine, bariatric, and laparoscopic surgery.
A second-generation physician whose father was a general practitioner, Pennington is a native of Athens, Alabama. He didn't originally plan on a medical career, he says, but gravitated toward it when he was in college.
"My father was a small-town physician who was gone a lot," he says, "and I knew the impact that the pressure could have on a family. But when I became more mature and had other influences in my life, it became more attractive to me to have a career that allowed me to serve people.
"What drew me toward surgery is that it provides the ability to intervene decisively in someone's life and see a definitive result. Personally, that's very gratifying."
