If there isn’t esophageal damage, your doctor might give you a pH monitoring test to assess the level of acid hitting your esophagus. “A pH of less than four is considered abnormal,” Ganz says. For the test, a capsule about one-half the size of a pen cap is inserted into your esophagus via a catheter threaded through your nose. The capsule communicates wirelessly with an i-Pod-sized recording device that you wear around your neck for 24 to 48 hours as you go about your daily routine. “Esophageal impedance” is another catheter-through-the-nose test that looks for reflux of gas or other liquids.

 

Surgical Options

Fundoplication, a surgery in which the upper part of the stomach is wrapped around the lower esophageal sphincter to strengthen it, is an option for those with severe reflux or who’ve developed GERD at a young age and want to avoid a lifetime of medications. The surgery can be done laparoscopically, through tiny abdominal incisions.

Barrx Medical in California has developed a new surgical technique for removing damaged esophageal tissue in cases of Barrett’s esophagus. (Prior to this, treatment options have been “watchful waiting” and, if cancer developed, sometimes removal of the esophagus.) Approved by the FDA in 2001, Barrx’s technology uses radio-frequency energy to burn away damaged tissue.

After 15 years of living with Barrett’s, Ringhofer last year participated in one of Barrx’s ongoing clinical trials; Dr. Ganz performed the procedure. So far, Ringhofer is cancer free. Now 54, he says he doesn’t have any more heartburn or swallowing troubles, although he still takes one dose of a proton-pump inhibitor each day to control stomach acid.

As CEO of New Brighton–based graphic design firm The Jeffrey Group, Ringhofer travels a lot less than he used to, enabling him to stick to an early dinner time: “If there’s a choice for dinner reservations, I’ll still take the seven o’clock rather than the nine o’clock.”


The Acid Test

If you can answer “yes” to two or more of these questions from the American College of Gastroenterology, you should ask your doctor whether you might have GERD, gastroesophageal reflux disease.

1} Do you frequently experience one or more of the following symptoms?:
A. An uncomfortable feeling behind the breastbone that seems to be moving upward from the stomach
B. A burning sensation in the back of your throat
C. A bitter, acid taste in your mouth

2} Do you often experience the above problems after meals?

3} Do you experience heartburn or acid indigestion two or more times per week?

4} Do you find that antacids provide only temporary relief from your symptoms?

5} Are you taking prescription medication to treat heartburn, but still experiencing symptoms?



Make It a Tighter Spot

Twin Cities companies are building barriers to acid reflux. Two local companies are working on new technologies that would tighten the seal on the lower esophageal sphincter (LES), the band of muscle that relaxes to let food into the stomach and contracts to prevent stomach acid from going back up.

Carbon Medical Technologies in St. Paul is conducting clinical trials of an injectable gel that contains microscopic carbon beads. When they’re injected into the sphincter via a tiny catheter, the beads form “a doughnut-like ring around the LES,” says Dean Klein, Carbon’s CEO. “Now you have closed off the internal diameter of the sphincter a bit, creating a barrier to acid.”

Klein notes that his company’s technology is already being used in a similar way to treat urinary incontinence. (That product is Durasphere EXP, which was approved by the FDA in 2003.) Klein expects to commercialize his company’s GERD technology by the end of 2008.

Maple Grove–based Torax Medical uses a necklace of beads, each with a magnetic core, to create more pressure and a tighter seal around the sphincter. The device is implanted via laparoscopic surgery. “The magnetic attraction creates a pressure of about 20 millimeters of mercury,” says Torax CEO Todd Berg. “The pressure is sufficient to restore the barrier function of the native, existing sphincter muscle.” Swallowing creates a pressure “as high as 50 to 100 millimeters of mercury,” he says, which is sufficient to separate the beads and allow food to pass through the esophageal sphincter.

Development is nearing the clinical-trial stage. To date, Torax has raised $13.5 million from Minnesota’s Mayo Medical Ventures and Thomas McNerney & Partners, and California–based Sanderling Ventures.

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