Therapy

Therapy aims to eliminate the symptoms, which impair your life quality and productivity and to prevent the cancer development. The management includes life style, medical and surgical therapy.

Medical Therapy

Medical therapy includes antacids, proton pump inhibitor (PPI) and histamine 2 receptor blocker and works by blocking the gastric acid secretion and thus reduces the acidity of the Reflux . As a consequence Heartburn and acid regurgitation are eliminated in the majority of GERD patients. The type and dosage of the therapy are individually tailored according to the results of the diagnostic tests ( Endoscopy , histopathology, manometry, Reflux monitoring ) and the symptom response.

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Surgical therapy: fundoplication & magnetic sphincter

Gastroesophageal reflux disease ( GERD ) results from the impairment of the competence of the lower esophageal sphincter, this is the Anti reflux mechanism within the lower end of the esophagus. Surgery is conducted laparoscopically and works by improving the function of the sphincter by either enwrapping the lower end of the esophagus with a portion of the Stomach ( Fundus ; Fundoplication ) or by placement of a magnetic pellets containing ring (magnetic sphincter augmentation, LINX System) around the outlet of the gullet.

Based on the wish of the patient, the magnetic sphincter (LINX) operation is offered as a day care procedure or with over night admission. Fundoplication includes over night admission.
The antireflux surgeries are offered by our collaborating surgeons under general anesthesia in our associated private hospitals (Privatklinik Josefstadt Confraternität; Wiener Privatklinik; Vienna General Hospital, Medical University Vienna). Indication and type of antireflux surgery is decided based on the findings obtained from the diagnostic tests (( Endoscopy , histopathology, manometry, Reflux monitoring ). It will be a great pleasure for us to inform you on antireflux surgery for the treatment of your GERD .

Radiofrequency ablation of Barrett‘s esophagus (RFA, HALO®)

RFA serves cancer prevention.
Barrett‘s esophagus affects 10%-30% of GERD patients and is a Reflux induced premalignant condition within the lower end of the esophagus (0.5% annual cancer risk). RFA is a novel, effective, minimal invasive, endoscopic procedure for durable elimination of Barrett‘s esophagus. RFA (HALO®) takes 20-30 min and is offered as a day care procedure under general anesthesia.
The indication for RFA is based on the findings obtained during Endoscopy , histopathology of the biopsies, Esophageal manometry and Reflux monitoring .
RFA uses ballon catheter (HALO® 360) or focal endoscope mounted ablator systems (HALO® 60,90) for the administration of radiofrequency (RF) energy pulses to the inner layer of the esophagus, which destroy the Mucosa and thus eliminate the Barrett‘s tissue. Following RFA and proton pump inhibitor (PPI) therapy the Mucosa heals by the formation of a Barrett‘s - free tissue in 70% and 92% after 1 and 2-3 RFA sessions, respectively. Thus it usually takes 2-3 RFA (HALO®) sessions to eliminate all Barrett‘s esophagus. Post RFA symptoms respond to medical treatment and include mild Heartburn , epigastric discomfort and pain. Therefore you are recommended to take pain killers (for 10 days) and PPI therapy (until the 8 weeks follow up visit) after the RFA procedure. Eight weeks after RFA we invite you to undergo an interview with your physician, conduct the life quality assessment and sedated Endoscopy with Biopsy sampling to assess the effect if RFA (i.e elimination of Barrett‘s esophagus). Feel free to contact us to learn more about RFA and Barrett‘s esophagus.

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Schematic drawing of HALO® 360 radiofrequency ablation of Barrett's esophagus. Via the treatment balloon (HALO® 360) the radiofrequency energy is delivered to the esophageal Mucosa . As a consequence the Mucosa is destroyed and ablated. Two months after the ablation Barrett's esophagus is eliminated in 70% of the cases.

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