Endoscopic radiofrequency versus a sham procedure for treatment of gastroesophageal reflux disease Hosny Salama a , Dalia Omran a , Eman Medhat a , Hanan Abdel Haleem a , Hisham El Khayat b and Alaa Esmael b a Department of Endemic Medicine, Faculty of Medicine, Cairo University and b Department of Tropical Medicine, Theodor Bilharz Research Institute, Cairo, Egypt Correspondence to Dalia Omran, Department of Endemic Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt Tel: +0100087802; fax: 23688805; e-mail: daliaomran2007@yahoo.com Received 30 November 2010 Accepted 11 February 2011 Egyptian Liver Journal 2011, 1:56–60 Background and study aims Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disorder affecting approximately 20% of adults in the world. Over the past few years, several endoscopic therapies have been proposed for the treatment of GERD. The aim of this study was to assess the outcomes in patients with GERD receiving medical treatment compared with another set of patients subjected to endoscopic radiofrequency energy ablation (Stretta procedure). Patients and methods This was a prospective, randomized, sham-controlled study. Sixty-one patients were enrolled; 31 patients were subjected to the Stretta procedure (group A). In group B, 30 patients underwent a sham Stretta procedure (mirror of the active procedure in all aspects, except that there was no deployment of the electrodes). They were treated medically. Results Stretta is associated with a modest improvement of GERD symptoms, pH control, lower esophageal sphincter pressure at 6 months, and complete stoppage of patients to all medical therapies (35%). Medical treatment was associated with poorer pH control than Stretta after complete stoppage of drugs and most of the patients who had GERD symptoms and esophagitis relapsed within 6 months after medical treatment cessation. Conclusion Endoscopic radiofrequency energy (Stretta procedure) is considered a safe and effective measure for the treatment of GERD. Keywords: endoscopic radiofrequency energy, gastroesophageal reflux disease, medical therapies Egypt Liver J 1:56–60  c 2011 Egyptian Liver Journal 2090-6218 Introduction Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disorder affecting approximately 20% of adults in the world [1]. GERD has a substantial impact on patient quality of life and use of healthcare resources [2]. The pathophysiology of GERD is multi- factorial and often includes low resting pressure of the lower esophageal sphincter (LES) and occurrence of transient LES relaxations. This episodically exposes the esophageal body to gastric acid and enzymes [3,4]. The current therapy for GERD begins with lifestyle changes and medical treatment, which prove to be adequate or effective for more than 90% of patients. Such therapy usually must be maintained long term because the rate for recurrence of symptoms is as high as 90% after cessation of medication. In addition, long-term drug therapy is associated with issues of cost, compliance, and long-term safety [5]. Patients who do not tolerate medication, who respond inadequately to medication, or who wish to avoid life-long drug therapy may be considered as candidates for surgery. Such surgery necessitates general anesthesia, has a mortality rate of approximately 0.2%, and can be associated with additional morbidity including dysphagia, gas-bloat syndrome, and postprandial fullness [6]. Over the past few years, several endoscopic therapies have been proposed for the treatment of GERD [7–15]. Delivery of radiofrequency (RF) energy into tissues causes a circumscribed thermal coagulative necrosis that heals by fibrosis [16–18]. The aim of this study was to assess the outcomes in patients with GERD receiving medical treatment com- pared with another set of patients subjected to RF energy ablation (Stretta procedure). Patients and methods This was a prospective, randomized, sham-controlled study. Of the 543 patients with GERD who were 56 Original article 2090-6218  c 2011 Egyptian Liver Journal DOI: 10.1097/01.ELX.0000397026.33294.5f Copyright © Egyptian Liver Journal. Unauthorized reproduction of this article is prohibited.