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KPJ Sabah: Malaysia first private healthcare institution provides GERD treatment

15th November, 2015

By PAUL MU Paul@newsabahtimes.com.my

KOTA KINABALU: KPJ Sabah Specialist Hospital celebrated a historical moment yesterday for being the first private healthcare institution in Malaysia to provide treatment for gastro-esophageal reflux (GERD).

GERD is a very common digestive disease affecting every one in three people in Malaysia and around the world, said KPJ Sabah physician and gastroenterologist Dr Nerenthran Loganathan.

It is a troublesome condition where the stomach acid moves up the food pipe (esophagus) and causes acid burn and ulcers in the surrounding area which is often chronic and relapsing, he said.

“Most people suffering from this condition usually complain of heartburn sensation, upper abdominal pain, fullness or bloating sensation of the stomach, regurgitation, night cough, hoarseness of voice, belching and sometimes have wheezing,” explained Dr Nerenthran.

The main causative mechanism is disruption of the barrier at the lower esophageal splinchter which is located at the junction of the stomach and the esophagus, he said.

Dr Nerenthran who is also the endoscopy unit head said: “Most of our population have this symptom but they are suffering silently and this condition can lead to serious complications in the long term if not treated.”

According him, most people begin to experience GERD during their teenage life where they would either go to the pharmacies or see the general practitioners but without getting the proper treatment.

“Now the treatment is available at KPJ Sabah and this is part of our vision for the centre of excellence in private healthcare where we are introducing a new technique and procedure for the benefit of patients.

“So today I am going to do three procedures and it takes about 45 minutes to one hour to complete and it is done under conscious sedation.

“This is an outpatient procedure where the patient need not be admitted in the hospital as they can go home after two to three hours sleep after the treatment. The patient has to fast first before coming in.

“And it takes about four to six weeks to show some improvement, almost 80 per cent of patients undergo this treatment can gradually reduce their medications whilst a very small percentage may still require a second procedure after six month to one year,” said Dr Nerenthran.

The procedure is relatively very safe with only one per cent of complication risk, he said, adding that the procedure can also redress the barrett’s esophagus which is a precancerous condition of the lower food pipe.

“Previously there are no treatment for barrett’s esophagus as the patient would go for the surgery when the early sign of cancer is detected through the observation or wait,” he explained.

Now is an exciting time for all those suffering from GERD as they have the option to do the procedure because nobody wants to be operated as it comes with significant risk of complications, bleeding, infection and others, he said.

“The procedure is done using a device called Stretta which produces a high radio frequency to lower the food pipe muscle in order to stimulate growth of the muscle to prevent the gastric from coming up and causing heartburn or reflux symptom,” explained Dr Nerenthran.

The procedure was introduced in the US and Europe some 10 years ago but only in the last four years the US FDA (food and drug administration) gave its approval, he recalled.

To date, more than 20,000 procedures have been successfully done around the world, said Dr Nerenthran who received his training in US.

Before this, the procedures were done mostly in US and Europe, but the Queen Elizabeth Hospital (QEH) here could stand proud for being the first government hospital to perform the procedure in the entire Asia Pacific region on May 20, 2014, said Dr Nerenthran who was one of the two doctors in QEH to carry out the procedures on two patients.

“Of the patients, one of them responded well to the procedure whilst the other one still requiring medication but at a reduce dosage,” he said.

Although the procedure which is an American technology is available but not many people could afford the treatment because it cost RM15, 000 per session and this is the main issue, he said.

“The medication is also not that cheap and it cost about RM5 to RM7 per tablet, imagine if you take it every day for the next four to five years, it is a lot of money and this haven’t include the consultation fee and procedure,” he said.

In the past, the only treatment available was the proton pump inhibitors to reduce the gastric which has side effect in the long term and needed surgery but the operation will be the last resort since we have the procedure now, he said.

Based on reports, he said almost 80 per cent of GERD is caused by a congenital condition known as hiatus hernia whereas other 20 per cent is caused by certain food like high fat containing foods, coffee, tea, chocolate, spicy food, carbonated drinks and sour drinks.

Other contributory factors include smoking and alcohol, obesity, tight garments which elevates the abdominal pressure. There are other rare conditions causing increased in stomach acid production for example ‘Zollinger Ellison’ syndrome, delay in stomach movements especially in people suffering from long standing diabetes.

Since GERD is an acid sensitive disease, he said the goal of treatment is improve symptoms, heal ulcers and prevent long term complications or it will lead to erosions and ulcers at the lower esophageal sphincter known as erosive esophagus.

“Long term oesophagitis will cause narrowing of the food pipe and may lead to cancer of the oesophagus,” he warned.

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