GERD gone

TIF procedure put out fire of heartburn and reflux

TIF procedure patient Carl Swanson sitting outside a cafe

When Carl Swanson was diagnosed with GERD (gastroesophageal reflux disease) nearly 25 years ago, one of his main symptoms was painful, persistent heartburn.

He had to carefully watch what he ate, and choosing the wrong type of food or eating too late in the day would result in a misery-filled episode of burning and discomfort in his chest and throat.

The symptoms were worse in the evening. Swanson had to elevate his upper body when he went to bed at night to keep the burning at bay and to avoid the regurgitation that left a bitter taste in his mouth.

"Anytime I was in a prone position or ate the wrong kinds of foods, like pepperoni pizza, I suffered the consequences," Swanson said. "It also made traveling difficult. Everywhere I went, I needed to make sure I was able to elevate my head at night."

Swanson's GERD was brought on by a large hiatal hernia, which occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the abdomen from the chest.

He also had Barrett's esophagus, a condition in which erosion of the esophagus could eventually lead to cancer.

Sleeping on a wedge and taking PPIs (proton pump inhibiting medication that reduces stomach acid) helped moderate Swanson's symptoms, but he experienced side effects from the PPIs.  

"The medication kept my symptoms under control, but I had issues with recurring bouts of anemia that would make me tired and weak and I would have to take supplements," Swanson said.

Long-term use of PPIs could also be associated with potentially dangerous side effects, including increased risk of bone fractures and a potential link to increased risk of dementia, according to JAMA Neurology.

"I always had the goal of getting off the PPIs, but because of my Barrett's esophagus, I was not a candidate for procedures to repair my esophageal valve," said Swanson.  

Swanson underwent treatment to eradicate the Barrett's esophagus, and then he was ready to seek a more permanent solution to eliminate the GERD.

TIF extinguished the fire

"I saw that Baptist Health did hiatal hernia repair and I knew something needed to be done to fix the valve in my esophagus, so I contacted them," Swanson said.

Swanson had a consultation with Craig Morgenthal, MD, a surgeon at the Baptist Center for Bariatric and Reflux Surgery. Dr. Morgenthal ordered a series of tests and determined that a laparoscopic hernia repair, along with Transoral lncisionless Fundoplication (TIF) was the best treatment option for Swanson.

The TIF procedure is a minimally invasive technique that can usually be performed without visible incisions. The procedure treats GERD by reconstructing the anti-reflux valve. When a patient like Swanson has a hiatal hernia, it will be repaired laparoscopically with small incisions, followed by the TIF procedure.

The valve system allows food to pass normally while preventing stomach contents from refluxing up into the esophagus. The procedure has been shown to reduce or eliminate symptoms of GERD.

"Dr. Morgenthal was great. He thoroughly explained the procedures to me," said Swanson. "He has a very good bedside manner in terms of assuring you that the procedure is safe and you'll be in good hands. He was very quick to answer all of my questions."

Swanson went home from the hospital the day after the combined laparoscopic hiatal hernia repair and TIF procedures, and the following day, he was able to return to a relatively normal schedule, including going for a long walk. Within a few weeks he was eating a normal diet and had resumed running and strength training.

"I feel a lot better now," said Swanson. "I no longer take PPIs and I can eat pepperoni pizza without any problems. I haven't had any issues with reflux and no longer have issues with heartburn or regurgitation, so I'm doing well. The TIF procedure was so worthwhile."