Electrical stimulation for gastroesophageal reflux disease: Formal randomized clinical trials are needed

Abstract

THE DESCRIPTION OF ELECTRICAL STIMULATION of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease (GERD) by Rodriguez et al in this journal is a most interesting study. The authors report a 2-year follow-up of the symptom benefit of electrical therapy for patients with moderate to severe GERD symptoms. The improvements are profound with almost universal success in the elimination of reflux symptoms after implantation of the device and are backed up by objective testing with pH monitoring. It seems that there are no side effects of the treatment. There is no other therapy for GERD with this magnitude of effect or lack of side effects. Neural modulation of the lower esophageal sphincter is a novel approach to the treatment of reflux, and its mechanism of action remains uncertain. Some possibilities include stimulation of the lower esophageal sphincter within the wall of the esophagus, stimulation of the adjacent diaphragm, and modulation/inhibition of the transient lower esophageal sphincter relaxations that are responsible for episodes of pathologic reflux. A unique aspect of this new technology is its apparent lack of side effects. The combination of total symptom control without side effect makes it seem tobe toogood tobe true.There isno reasonnot to believe the initial results, but it is important to understand the studies before jumping to the conclusion that this might be the panacea for all reflux.