The Magnetic Bracelet and Its Application in GERD

Introduction:

The main function of the digestive organs is to help in the digestion process. Several substances in the form of juices are secreted by various parts of the digestive tract. Gastric juice is secreted by the stomach. Ideally, it should be confined to the stomach only. But, in some cases, retrograde movement of the gastric juice in the esophagus can be observed. This condition is known as gastroesophageal reflux disorder or GERD. Around 18 to 27 percent of the adult population in the United States suffers from this condition. Over the years, several methods have been used to treat this condition. But, the treatment outcomes are not satisfactory.

What Is GERD?

GERD, or gastroesophageal reflux disease, is a chronic condition characterized by the retrograde flow of the stomach's contents to the esophagus. This causes increased acid exposure to the esophagus and esophageal lumen. As a result, erosion of the esophageal lining causes severe discomfort.

Pathophysiology

Gastric juice is composed of various substances like hydrochloric acids and enzymes like pepsin and lipase. The presence of hydrochloric acid is responsible for the acidic nature of the gastric juice. Several protective mechanisms of the stomach help prevent injury of the gastric tissues due to the acidic contents.

Anti-reflex barrier, a complex anatomical zone, presents the retrograde movement of the acidic contents into the esophagus. This anatomical zone consists of the lower esophageal sphincter, the extrinsic crural diaphragm, and the gastroesophageal flap valves.

Disorder of the lower esophageal sphincter is responsible for this condition. Usually, the lower esophageal sphincter maintains a high-pressure zone. A deceased pressure of the lower esophageal sphincter and lower relaxation of the lower esophageal sphincter is associated with dysfunctioning of the lower esophageal sphincter. Chronic decrease in the lower esophageal resting tone is also another reason responsible for gastroesophageal reflux disorder.

The factors associated with such causes are:

• Endogenous hormones like progesterone in pregnancy and cholecystokinin.

• Medications like calcium channel blockers and nitrates.

• High-fat diet, smoking, chronic alcoholism, and chocolate.

• Hiatal hernia is another factor associated with this disorder. Hiatal hernia causes separation of the crural diaphragm from the lower esophageal sprinter. This causes increased exposure of gastric acid to the esophagus.

• Decreased gastric emptying is another factor responsible for gastroesophageal reflux disorder. Increased retention of acid causes distension and retrograde movement of the acid into the esophagus.

• Increased esophageal sensitivity is another contributory factor in the development of GERD. Thermal, mechanical, and chemical stimuli increase the sensitivity and cause acid movement into the esophagus.

Symptoms

The symptoms of gastroesophageal reflux disorder are:

• Frequent episodes of heartburn are the most common complaint of GERD patients. Patients often give a history of pain and burning sensation in the chest radiating towards the mouth. GERD is the most common cause of non-cardiogenic chest pain.

• Sourness in the back of the mouth is most commonly noticed in the morning.

• Erosion of the lingual surface of the teeth can be noticed.

• Increased incidence of throat clearance and hoarseness can be seen.

• Breathing problems, cough, and wheezing can be seen. Acidity increases the chance of bronchospasm, which is associated with an increased incidence of asthma attacks.

• Patients often complain of fullness and the presence of a lump in the throat.

What Are the Treatment Options?

The treatment options used for the treatment of GERD are:

1. Lifestyle Modification: Lifestyle modifications are the most effective and primary way to manage GERD. Weight loss and BMI (Body mass Index) reduction are considered as one of the key factors for controlling GERD. Living a healthy lifestyle, consuming food at regular intervals, and stopping consuming acidic food is beneficial in controlling gastroesophageal reflux disorder. Lifestyle modifications like the stoppage of alcohol and smoking are also important.

2. Proton Pump Inhibitor (PPI): This is the most common drug used for the treatment of GERD. Drugs like Lansoprazole, Omeprazole, Esomeprazole, and Pantoprazole help to reduce the secretion of acids. Also, symptoms of GERD like heartburn, chest pain, and discomfort can be minimized by these medications.

3. Surgical Treatment: Different surgical options can be explored. Treatment of a hiatal hernia is one of the main treatment options in GERD cases linked to total hernia. Surgical options like laparoscopic Nissen fundoplication (surgical treatment for tightening the junction between the esophagus and stomach) and laparoscopic anterior 180-degree fundoplication can be used to treat GERD. In cases of obese people, gastric bypass surgery can be useful.

What Is Magnetic Bracelet in GERD?

Magnetic bracelets are implantable devices that can be used for the treatment of gastroesophageal reflux disorder. These are also called LINX devices. These are actually titanium beads in which magnates are placed inside, and titanium beads are held together with the help of a titanium weir. These rings are placed through a keyhole incision in the belly. The diameter of these rings is around 1.5 inches but may vary according to the number of beads. The number of beads may vary from 13 to 17 beads. The individual magnates are made up of neodymium-iron-boron with 5.8 millimeters in diameter and 4.3 millimeters in width. In the separated position, the magnetic force is lowest, and it is 0.07 Newton. The magnetic force is the highest (39 Newton) when the beads are held together.

This ring encompasses the junction of the esophagus and the stomach at the lower esophageal sphincter. The magnetic force of the beads pushes the junctional area of the esophagus and stomach in the inward direction and prevents the escape of gastric juice into the esophagus. But, the magnetic force among the beads is not strong enough to prevent the movement of the food from the esophagus to the stomach.

The benefits of this technique are:

1. This is a noninvasive surgery with minimal surgical interventions.

2. Patients can be discharged on the same day.

3. Recovery is faster with fewer surgical complications.

4. Requirement of fewer medications.

Conclusion:

Gastroesophageal reflux disorder is one of the common chronic digestive disorders. This is caused by the movement of the gastric juices into the esophagus. This causes erosion of the gastric epithelium. As a result, patients feel symptoms like heartburn, chest pain, and sourness in the mouth. Drugs like proton pump inhibitors can be used for the treatment of such cases. Magnetic bracelets are implantable devices that are placed in the junction of the esophagus and the stomach. This prevents the movement of the gastric contents in the stomach. The surgical complications are fewer in such cases.