Bad Ideas for Acid Reflux: Chrissy Teigan’s Ridiculous Reflux Tape and Some Dubious Endoscopic Antireflux Procedures
- Today’s snake oil? Since millions of Americans have acid reflux, there is a great opportunity for exploitation by unscrupulous people selling useless products with false or unproven health claims. And the prize for amazing worthlessness goes to Reflux Tape, kinesthesiology tape (K-tape) for acid reflux.
- Honorable mention for bad ideas goes to: Digestive enzymes, apple cider vinegar, HCL and pepsin. Digestive enzymes don’t help anyone; they’re useless; and vinegar, HCL, and pepsin can definitely make reflux worse. The only truly effective long-term reflux treatment is a low-fat, low-acid diet and healthy lifestyle.
- I am asked about surgery all the time. And although “who is a candidate for a reflux procedure” is not the focus of this post, there are some people who are candidates for antireflux procedures. In my opinion, there are two good procedures, Stretta and fundoplication, that are effective; and four procedures (in the bad ideas department), EndoCinch, Gatekeeper, TIF, and Linx that should be avoided.
“Reflux Tape” Is Total Bullsh*t
From Chrissy Teigan’s (11-11-22) Instagram, Thank you Dr. Berlin for my acid reflux tape … it works!!!??? The tape in question is kinesthesiology tape (K-tape) that is mostly used by athletes for musculoskeletal problems. Well, Dr. Berlin? Actually, he has never said anything about using K-tape for indigestion or reflux; and in regard to pregnancy, he has only said that he uses tape to relieve neck, shoulder, and back pain.
If you Google “kinesthesiology for indigestion or acid reflux?” you’ll find nothing; if you search the medical literature (PubMed) for “kinesthesiology,” you’ll find nothing, and Wikipedia also draws a blank. As an expert on acid reflux, let me shout from the rooftop that there is no possible way that putting K-tape on your pregnant belly could possibly be of benefit for your reflux. (It might have a placebo effect.) “Reflux Tape” is total BULLSH*T … So please people, don’t buy K-tape for reflux!
My Reflux is Awful: Which Procedures Are Good and Which Are Bad?
The purpose of this blog is not to establish surgical criteria for people with reflux; however, I will say that those with recalcitrant reflux despite prolonged, conscientious, and maximum medical (including diet-lifestyle) management, as well as those with life-threatening reflux do fit my criteria for surgery; for example, see Bronchitis Blog. Fewer than 5% of my severe reflux patients ever require an antireflux procedure.
Americans mistakenly believe that there is a pill or procedure for everything. However, being inconvenienced by reflux symptoms and being unwilling to modify self-sabotaging behaviors are not grounds for having an antireflux procedure. Inconvenience is never a surgical indication; this is a cautionary tale; here’s why:
Illustrative Case example: In 2017, a 37-year-old Wall Street trader can to see me after a “failed fundoplication,” that being the most effective anti-reflux surgery that there is. Interestingly, I remembered having seen this patient two years before this visit.
In 2015, he presented with heartburn, post-nasal drip, and loud snoring. By exam and reflux testing, he had severe reflux (GERD & LPR). I tried to start him on an anti-reflux program, but he balked. He was unwilling to change his eating and drinking habits. Indeed, he went to a steakhouse or its equivalent almost every night and late, and was a heavy drinker. Not surprisingly, he failed to keep his follow-up appointment with me.
Subsequent to my 2015 interaction, the patient apparently saw another doctor and ended up having a Laparoscopic Nissen Fundoplication. But two year later, he was back to see me and back to square one, actually, his symptoms were worse than before the surgery. He was very angry at his surgeon, even talking about a malpractice lawsuit. Indeed, he had come back to me so that I could document that his reflux was severe and that his surgery had been done badly.
I performed endoscopy, Transnasal Esophagoscopy (TNE), and found that the surgery (fundoplication wrap) was in tact; however, he had severe inflammation in the lower esophagus, at the fundoplication. His surgical repair was so swollen, inflamed, and stiff that it no longer was working. The problem was severe reflux, not bad surgery.
I intervened with a heavy hand. I told him that he was alcoholic — three “double” cocktails and a bottle of wine nightly — and he agreed to get help. In addition to doing my anti-reflux program, including closing the kitchen at 6:00. He recognized that he was alcoholic, stopped drinking, and joined AA. Six months later, he was a new man; and on TNE, everything looked great including his fundoplication.
This is a cautionary tale.
Comment: There is no “magic bullet” for acid reflux, that is, no procedure that can fix reflux in the face of a really bad diet and lifestyle. And that brings me to a discussion of several endoscopic reflux procedures: EndoCinch, Gatekeeper, TIF, Linx, and Stretta … all designed to improve the barrier function of the LES (lower esophageal sphincter).
Dr. Koufman’s Opinions of Endoscopic Antireflux Procedures
The EndoCinch Procedure is an endoscopic procedure in which the doctor puts sutures in the lower esophagus in an attempt to tighten the LES. This procedure is not superior to placebo; it is a sham. As of this writing, I believe that EndoCinch has been discontinued, taken off the market, anyway … Conclusion: EndoCinch is/was a dog with fleas … Avoid It!
Gatekeeper TM System (Medtronic Inc.) involves the implantation of a hydrogel “prosthesis” in the walls of the esophagus at the LES with the assumption that the bulk of the prosthesis will help close the LES. The main problem with Gatekeeper is that the reflux relapse rate is 60%. In addition, it is problematic because of the likelihood of migration of the gel. Cost is $2- $4,000. Conclusion: This is a bad-idea, bad procedure … Avoid It!
TIF (Transoral Incisionless Fundoplication) is another endoscopic, so-called “minimally invasive procedure” to treat reflux. The idea is to perform a fundoplication endoscopically. Unfortunately, when surgeons go in to perform fundoplication following TIF failure, they find that the TIF looks awful, and that the scarring makes the “re-do” surgery very difficult. Worse than that, long-term follow-up reveals that 73% were back taking reflux medication; thus, the overall success rate of TIF is 27%. Costs range from $7,000-$22,000 depending on insurance coverage … OUCH! Conclusion: This is a bad-idea, bad procedure … Avoid It!
LINX Reflux Management System. With the Linx procedure, a ring of magnets is put around the lower esophagus. Linx, a product of the Ethicon Company (a division of Johnson & Johnson), is currently in vogue, and a lot of money is being put into advertising for this medical device. Cost is $15,000. The company says that Linx is safe and designed to last a lifetime … nah!
Remember the Angelchik! Introduced in 1979, the Angelchik Prosthesis consisted of a C-shaped silicon ring fitted around the lower esophagus supposedly to improve LES function. It was popular at the time because of ease of insertion. Ultimately and unfortunately, 70% of patients developed dysphagia (difficulty swallowing) and there were a lot of complications including migration of the device and erosion of surrounding structures. An estimated 25,000 Angelchik devices were inserted worldwide, but by 1990, it was finished. And there were a lot of lawsuits against the inventor and manufacturer, not to mention malpractice suits against doctors.
Is the Linx a Future Angelchik Catastrophe in the Making? Perhaps. putting anything metal around a soft, hollow, moving organ like the esophagus is a bad idea … I believe that eventually there will high levels of failure and complication, migration of the device and erosion into the esophagus.
The Linx was introduced in 2012 (about 10 years ago), and we already know that there are migration and erosion complications; in addition, the failure rate may be as high as 50%. I wonder what the data will show in 20 years? Personally, I have already seen scores of patients with failed Linx procedures and/or complications requiring surgical removal. Conclusion: This is a bad-idea, bad procedure … Avoid It!
Is There a Procedure or Surgery That Works?
The focus of this post is bad ideas; and I don’t want this to be about my surgical selection criteria; but that said, there are two procedures that I recommend to less than 5% of my reflux patients: Stretta is a non-invasive, endoscopic procedure, and laparoscopic fundoplication, is real surgery done in an OR. (Being laparoscopic means that it is done through small poke-holes rater than through a big abdominal incision.)
The Stretta Procedure is a safe and reasonably effective endoscopic treatment and nothing is inserted into the body. Stretta procedure is a non-invasive, outpatient procedure designed to tighten the LES. A Stretta device is inserted into the esophagus for a short period of time to deliver radiofrequency energy to the muscle tissue of the LES. The upside of Stretta is a 70% success rate with a low complication rate, and a cost is $4,000. No one knows how long a Stretta procedure lasts, but I have seen many patients get 2-4 years of relief, and then choose to have a second Stretta procedure. Conclusion: Medium-good option for properly-selected, “diet-compliant” patients with poor LES function.
Laparoscopic Nissen Fundoplication. This is the gold-standard antireflux procedure. The term fundo– plication defines itself. The fundus is the dome of the stomach, and in this procedure, the stomach dome is loosened up, wrapped around the esophagus, and plicated (sewed) to create a new tighter LES area. This surgery works 95% of the time; complications are low; and it costs $8- $16,000.
The three things that I would add: (1) Who the surgeon is, and her experience matters; this surgery is for surgeons who do fundoplications daily. (2) If you see a surgeon in consideration for this, ask how many fundoplications she has done. NB: The learning curve is 200 cases; also ask about her results and complications. (3) Do not let the surgeon sell you on a partial (270o) fundoplication wrap. If you are going to have surgery for reflux, especially respiratory reflux (LPR), you need a complete 360o wrap. In my experience, the failure rate with partials is high. Conclusion: Best option for properly-selected patients.