LINX for Acid Reflux: Side Effects and Esophageal Wall Compliance

LINX for Acid Reflux: Side Effects and Esophageal Wall Compliance

Jacqueline from Cypress Sent us this question: I have a lot of the long-term side effects from my LINX procedure and all my tests have come back normal. One of my new side effects is when the food gets stuck and I try to force it through with liquid I feel like I am going to pass out every time. My question is: “have you heard of this with any other patients and if so, what seems to be the problem?” Thank you for your time and answering my question

Dear Jacqueline,

At Houston heartburn and reflux Center, I don’t perform LINX surgery for several reasons. First, and most important, LINX is much less effective than Nissen fundoplication in controlling acid reflux. Second, LINX is more invasive than Nissen fundoplication given the fact that a foreign body is implanted around the esophagus. Third, LINX surgery is associated with an unacceptably high dysphagia rate when compared to a properly performed Nissen fundoplication. At Houston Heartburn and Reflux Center our post Nissen fundoplication dysphagia rate is very close to zero. We perform a floppy and short Nissen fundoplication that does not hinder esophageal motility and food passage from esophagus into stomach. We have achieved zero dysphagia rate with tailored, floppy Nissen fundoplication even in the setting of poor esophageal motility secondary to severe acid reflux.

LINX device mechanism of action is quite different from Nissen fundoplication. LINX device creates a pressure zone around distal esophagus. Esophageal contractions must overcome this barrier to facilitate food passage from esophagus into stomach. Furthermore, LINX device creates scar tissue formation around distal esophagus. Scar tissue decreases esophagus wall compliance. Decreased compliance causes dysphagia or difficulty swallowing despite normal sphincter relaxation and intact esophageal contractions on manometry. Esophageal wall compliance is measured using Endoflip.

Given your presentation, I recommend a thorough evaluation by a competent acid reflux specialist. Testing for dysphagia includes upper endoscopy, UGI contrast study, manometry and Endoflip. Treatment starts with endoscopic balloon dilation to break down scar tissue formation. If this approach fails LINX device removal and conversion to Nissen fundoplication are recommended.