Dysphagia and Persistent Acid Reflux after LINX Surgery

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Dysphagia and Persistent Acid Reflux after LINX Surgery

Sunny from San Antonio, TX sent us this question: “I had LINX device placed on September 1, 2020.  I have realized that eating fast causes Dysphagia.  My two questions are:

Q1. Even chewing food well before swallowing I have experienced dysphagia, where taking a few sips of warm water gets my food down.  Is this normal?

Q2. Even with LINX can one experience spontaneous reflux? Thank you.”

Dear Sunny,

Dysphagia or difficulty swallowing is very common after LINX surgery. LINX device creates a barrier against normal swallowing. This physical barrier has three components: lower esophageal sphincter pressure, esophagus wall compliance and diameter. As scar tissue forms around LINX device, both esophageal wall compliance and opening decrease. Furthermore, LINX device, a bracelet of magnetic beads, increases lower esophagus sphincter resting and residual pressures. As a result, your esophagus works harder to push food across this barrier leading to dysphagia. The weaker your esophageal contractions the more likely you are to feel dysphagia. You may have to drink some water to help food go down. In some cases, food doesn’t go down and it gets impacted in the esophagus. Over time, esophagus motility may further deteriorate leading to worsening dysphagia.

Endoscopic balloon dilation is utilized to break down scar tissue formation around LINX device. This approach may improve early dysphagia developing shortly after LINX implantation. Balloon dilation success rate decreases significantly when dysphagia develops several years after LINX surgery. Esophageal manometry is typically performed to evaluate esophageal motility. Results can be compared to pre-surgery manometry. If there is evidence of esophageal motility deterioration, LINX device removal is indicated to prevent further damage to esophageal function.

To conclude, dysphagia and LINX surgery go hand in hand given the device mechanism of action. A well performed Nissen fundoplication, on the other hand, is associated with less than 1% dysphagia rate.

Regarding your second question: “can reflux occur in the setting of LINX?”. The answer is yes. Unlike Nissen fundoplication, LINX procedure is not 100% reliable and effective in stopping acid reflux.