Long-term (>5 Years) Outcomes after Magnetic Sphincter Augmentation

Issue Highlights

Effect of Acid Suppressants on the Risk of COVID-19: A Propensity Score-Matched Study Using UK Biobank

American Gastroenterological Association Institute Technical Review on the Management of Gastroesophageal Reflux Disease

Gastroesophageal Reflux

Short-Term Outcomes of Laparoscopic Hiatal Hernia Repair with Consecutive Transoral Incisionless Fundoplication: A Prospective Multicenter Cohort Study.

Introduction: While laparoscopic fundoplication (LF) has been the treatment of choice for patients with gastroesophageal reflux disease (GERD) who remain symptomatic despite proton pump inhibitor (PPI) therapy, emerging interventions offer an alternative option. The aim of this study was to perform a systematic literature review to report symptomatic and physiologic impacts of therapeutic interventions to treat PPI nonresponsive GERD. Methods: A review of the PubMed, Cochrane, and EMBASE databases from 2005-2015 for GERD therapeutic interventions identified 2928 unique citations. All full-text, English language studies reporting interventions in adult populations with typical GERD symptoms on at least once daily PPI were included. Fifty-one studies met inclusion criteria and were categorized according therapy type: LF (21), endoscopic fundoplication (EF) (11), radiofrequency delivery (RFD) (10), magnetic sphincter augmentation (MSA) (6) and other (3) [Figure 1].Figure 1Results: As far out as 10 years, LF improves symptoms and physiologic parameters as measured by pH testing according; but PPI use increases (8.8% to 18.2%). EF improves GERD symptoms and eliminates PPI use in 58-93% of cases, but longest follow-up time is 3 years. In the only comparison of EF and LF, an open-label trial found better symptom remission rates (100% vs. 30%) and normalization of esophageal acid exposure (100% vs. 50%) with LF. RFD has mixed results. PPI independence ranges from 6.25-86.3% with RFD and only modest reductions in esophageal acid exposure (11.6% to 8.5%). MSA improves symptoms as far out as 5 years with normalization of acid exposure in 80% of patients and elimination of PPI in 75.3%. In an observational study, MSA, as compared to LF, provides similar improvements in GERD-HQRL scores, greater reduction in PPI use and better preservation of the ability to belch and vomit. Electrical stimulation of the lower esophageal sphincter, submucosal dissection and mucosal resection are emerging techniques that warrant further study. Results summarized in Figure 2.Figure 2Conclusion: LF remains the most proven option for the treatment of PPI nonresponsive GERD. EF and MSA are promising techniques with potentially fewer side effects, while evidence forRFD is mixed. Longer term, randomized trials comparing new techniques with LF are needed.

Nonresorbable copolymer implantation for gastroesophageal reflux disease: A randomized sham-controlled multicenter trial

BackgroundGastrointestinal (GI) complications are a major cause of morbidity and mortality in systemic sclerosis (SSc) [1]. Proton pump inhibitors (PPIs) are widely used to treat gastroesophageal reflux disease in SSc....

Background:Gastroesophageal reflux disease (GERD) is commonly treated with surgical interventions such as magnetic sphincter augmentation (MSA) or fundoplication (FP). This meta-analysis evaluates postoperative outcomes of MSA versus FP in GERD management.Methods:A systematic literature search was conducted across PubMed, Cochrane Library, ScienceDirect, and Embase up to April 2025, identifying studies comparing MSA and FP for GERD. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I2 statistic, and statistical significance was set at P < 0.05.Results:Twelve studies, published between 2014 and 2024, were included. No significant differences were observed in postoperative proton pump inhibitors (PPI) use (OR: 0.70, 95% CI: 0.30–1.67, P = 0.40, I2 = 85%) or GERD-HRQL scores (MD: 0.67, 95% CI: –0.57–1.91, P = 0.29, I2 = 68%) and dysphagia (OR: 1.12, 95% CI: 0.59–2.14, P = 0.72, I2 = 72%) between MSA and FP. MSA significantly improved the ability to belch (OR: 6.78, 95% CI: 4.49–10.22, P < 0.00001, I2 = 43%) and ability to vomit (OR: 5.85, 95% CI: 2.39–14.33, P = 0.0001, I2 = 82%) and reduced gas bloating risk (OR: 0.43, 95% CI: 0.25–0.75, P = 0.003, I2 = 54%) compared to FP.Conclusions:MSA and FP demonstrate comparable efficacy in GERD symptom control, PPI use, and dysphagia. MSA offers significant advantages in preserving the ability to belch and vomit and reducing gas bloating. Substantial heterogeneity in GERD-HRQL scores, postoperative PPI use, dysphagia, and ability to vomit warrants cautious interpretation, and further studies are needed to optimize surgical approaches.

Introduction: GERD is commonly diagnosed by improvement of upper gastrointestinal (UGI) symptoms on PPI therapy. Similar symptoms are reported in patients with CD and whether this is a manifestation of UGI CD or GERD is unclear. Data on the prevalence of GERD in CD do not exist. A preliminary study of patients with CD has shown gastroduodenal histologic findings of granulomas and focally enhanced gastritis, which are more specific to UGI CD, in 12% of patients with upper endoscopy (Diaz et al, 2015). Given the potential long-term side effects of PPIs, our aim was to evaluate the prevalence of PPI use and reported GERD symptoms in patients with CD. Methods: We performed a retrospective chart review of 499 patients with CD seen between September 2009 to May 2015 and grouped them using the Montreal Classification (MC). Each encounter was evaluated for pyrosis, regurgitation, globus, dysphagia, odynophagia, chest pain, postprandial abdominal pain, early satiety, bloating, and nausea. Use of acid suppressive therapy prior to the first visit and current use were also recorded, as were gastric emptying and pH studies if available. Results: The mean age of our 499 patient cohort was 39 years (range: 17-80), 49% males, mean BMI= 24.7 (range: 13-52). By MC criteria, 186 (37%) were L1, 80 (16%) were L2, 218 (44%) were L3, and 15 (3%) had upper and lower GI CD. Less than 5% of patients had gastric emptying or pH studies. 108 (21.6%) patients were on medications prior to their first visit with indications unknown and 111 (22.2%) patients were on acid suppressive therapy. Of the patients on acid suppressive therapy, 61% were not assessed for pyrosis, 88% were not assessed for regurgitation, and 82% were not assessed for postprandial abdominal pain. Other classic GERD symptoms were not assessed at higher rates (Table 2). Bloating and nausea were reported in 43 and 45% of patients on acid suppressive therapy, respectively.Table 2: Upper GI Symptoms Assessed While on Acid Suppressive TherapyConclusion: Many patients with CD are on PPI therapy without proper symptom screening or existing indications. Nausea and bloating are commonly reported in these patients and whether that is related to UGI CD, dyspepsia, or true GERD is unknown. Given the potential side effects of PPIs and the complications of CD, appropriate screening should be done to minimize PPI use. Further studies should prospectively evaluate CD patients through validated GERD questionnaires and endoscopic biopsies to better analyze which CD patients would benefit from PPI use.Table 1: Baseline Characteristics

Magnetic sphincter augmentation (MSA) was introduced in 2007 as an alternative surgical procedure for patients with gastroesophageal reflux disease (GERD). The majority of data since MSA's introduction has focused on short and intermediate-term results, demonstrating safety and high efficacy in terms of reflux symptom control, freedom from proton pump inhibitor use and normalization of distal esophageal acid exposure. However, GERD is a chronic condition that demands a long-term solution. Limited available data from studies reporting outcomes at 5years or later following MSA demonstrate that the promising short- and mid-term efficacy and safety profile of MSA remains relatively constant in the long term. Compared with Nissen fundoplication, MSA has a much lower rate of gas-bloat and inability to belch at a short-term follow-up, a difference that persists in the long-term. The most common complaint after MSA at a short-term follow-up is dysphagia. However, limited data suggest dysphagia rates largely decrease by 5years. Dysphagia is the most common indication for dilation and device removal in both early- and long-term studies. However, the overall rates of dilation and removal are similar in short- and long-term reports, suggesting the majority of these procedures are performed in the short-term period after device implantation. The indications and standard practices of MSA have evolved over time. Long-term outcome data currently available are all from patient cohorts who were selected for MSA under early restricted indications and outdated regimens. Therefore, further long-term studies are needed to corroborate the preliminary, yet encouraging long-term results.

Alternative Therapeutic Approaches to Chronic Proton Pump Inhibitor Treatment

White Paper AGA: Optimal Strategies to Define and Diagnose Gastroesophageal Reflux Disease.

Magnetic Sphincter Augmentation Superior to Proton Pump Inhibitors for Regurgitation in a 1-Year Randomized Trial

Background Gastroesophageal reflux disease (GERD) represents a common burden after bariatric procedures, particularly after laparoscopic sleeve gastrectomy (LSG). While GERD after LSG is usually treated with conversion to Roux-en-Y gastric bypass (RYGB), there are limited surgical options to manage medically refractory GERD after RYGB due to the altered anatomy. The use of magnetic sphincter augmentation (MSA) is one option, but the literature on this topic remains scarce. Aims To present mid- to long-term outcome of patients treated with MSA for GERD after RYGB. Methods We performed a retrospective single-centre analysis of data from patients who underwent laparoscopic MSA for GERD between August 2015 and December 2023, and who had previously RYGB. Outcomes were persistence/recurrence of GERD symptoms, use of proton pump inhibitors (PPIs) and need for redo surgery related to MSA complications or recurrent GERD. Results Of the 312 MSA procedures performed for GERD, we identified 13 patients who underwent laparoscopic MSA after RYGB. There were 10 female patients (77%), with mean age of 42.6 ± 13.7 years and mean BMI of 27.2 ± 2.7 kg/m2. Seven patients (54%) had de novo GERD. All MSA procedures included hiatoplasty. Median follow-up was 40 months (range 7-72) and median time between RYGB and MSA placement was 42 months (range 8-242). One patient (8%) required endoscopic dilatation due to persistent postoperative dysphagia. Two patients (15%) needed redo surgery: 1 redo hiatoplasty with adhaesiolysis and 1 conversion to esophagojejunostomy with implant removal. There was no erosion or migration of the MSA implant. Overall satisfactory control of reflux with discontinuation or reduction of PPIs was achieved in 9 patients (69%). Conclusion The use of MSA to manage refractory GERD after RYGB is a safe option and was effective in 69% of patients but is limited to patients with intact oesophageal motility.