How a blast of hot gas fired down the oesophagus could ease the agony of heartburn

A blast of hot gas could ease the agony of heartburn.

Argon gas is fired from a thin tube inserted deep into the oesophagus (food pipe) while the patient is under sedation.

It is targeted at an area around the valve where food passes from the oesophagus and into the stomach. This is where stomach acid often leaks back up into the food pipe, causing pain.

The heat from the gas ‘cooks’ the top layer of tissue in the oesophagus, causing it to tighten and shrink — narrowing the oesophagus in that area.

This reduces the space available for acid to seep through the valve, so easing the burning sensation.

Argon gas is fired from a thin tube inserted deep into the oesophagus while the patient is under sedation

A clinical trial testing the new approach is under way in Germany, involving 15 patients with severe heartburn.

Heartburn affects around one in three people at some point in their lives. It is caused by hydrochloric acid — produced in the stomach to break down food — flowing back up the oesophagus, causing pain.

This occurs when there is a fault in a valve, called the lower oesophageal sphincter, which controls the flow of food into the stomach and prevents the acid from going the other way.

Occasional heartburn can be treated with over-the-counter antacid pills, which dampen down the inflammation in the oesophagus caused by leaking fluids.

But an estimated eight million people in the UK suffer chronic acid reflux — known as gastro-oesophageal reflux disease (GORD) — where the lining of the oesophagus becomes damaged by excess acid exposure.

Risk factors include pregnancy and obesity — both increase pressure on the stomach — and certain medication (such as some high blood pressure pills or anti-depressants), which irritate and weaken the valve.

Most of those affected will benefit from drugs called proton pump inhibitors (PPIs), which lower acid production. But some patients need a surgical procedure, called fundoplication, where the top part of the stomach is stitched round the oesophagus to support the valve.

While this is generally successful, the procedure can cause problems such as burping, vomiting or pain when swallowing.

Now doctors at Garmisch-Partenkirchen Clinic in Germany are testing out the argon gas therapy as a possible alternative to surgery.

The technique, called argon plasma coagulation, is already commonly used in some types of gastric surgery as a way to stem bleeding.

A thin probe, called a gastroscope, is fed through the mouth and into the stomach. At the press of a button, argon gas is blasted from the tip in a bright beam of energy that cauterises damaged blood vessels — stemming bleeding.

In heartburn, the theory is that the same approach burns tissue around the lower oesophageal sphincter, causing it to shrink sufficiently and stop acid leaking upwards, without making it more difficult for food to move downwards.

Similar techniques are widely used throughout medicine to burn tissue in this way. A case report of one patient given the argon gas treatment — published in the American Journal of Gastroenterology in October 2021 — said heartburn symptoms all but disappeared within a couple of months of the procedure.

The patients in the trial will each have an area of tissue no bigger than 2cm blasted with the gas and kept in hospital for 48 hours before being discharged. Regular check-ups will determine how successful the procedure is.

Commenting on the approach, Laurence Lovat, a professor of gastroenterology at University College London, said: ‘The procedure is very simple and in theory it might work.

‘It’s well worth doing an initial small trial, but there have been many novel procedures for acid reflux that have fallen by the wayside.’

Those who suffer from atopic dermatitis could be more at risk of developing acid reflux

People with the skin condition atopic dermatitis are more at risk of developing acid reflux, reports a study by Korea University in Sejong, South Korea.

Research based on more than 9,000 adults with the skin complaint found they were 15 per cent more likely to suffer severe heartburn than others without dermatitis, reported the journal PLOS One.

One theory is that atopic dermatitis raises levels of a compound called histamine, involved in allergic reactions; some studies suggest high histamine levels weaken the muscles that control the valve between the oesophagus and the stomach.