Case Presentation: Gastroesophageal reflux disease (GERD) is a common disorder that is characterized by the backflow of gastric contents into the esophagus, leading to symptoms such as regurgitation and heartburn. While proton pump inhibitors (PPIs) are the mainstay of treatment, some patients experience refractory symptoms. Alternative therapeutic approaches of GERD may be warranted in these patients. This case report presents a 48-year-old female with a 5-year history of GERD that was unresponsive to maximal medical therapy, including PPIs and H2 receptor antagonists. Despite treatment, she experienced persistent heartburn, regurgitation, and nocturnal symptoms that significantly impaired her quality of life. Diagnostic evaluation, including esophagogastroduodenoscopy (EGD) revealed a small hiatal hernia and grade C esophagitis per Los Angeles criteria. 24-hour pH monitoring confirmed abnormal acid exposure associated with the patient’s symptoms. Given the patient’s refractory nature of her GERD, she was deemed a candidate for Transoral Incisionless Fundoplication (TIF), a minimally invasive endoscopic procedure using the EsophyX device to create a valve at the gastroesophageal junction. Postoperative follow-up at 1, 3, and 6 months demonstrated significant symptomatic relief, normalized acid exposure, and resolution of esophagitis. This case highlights TIF as a promising option for managing refractory GERD, offering effective symptom control and improved quality of life while avoiding the risks associated with long-term medication use. Further research is needed to validate the long-term efficacy and safety of this novel treatment modality.
Discussion: Gastroesophageal reflux disease (GERD) is a prevalent condition characterized by the backflow of stomach contents into the esophagus, leading to symptoms such as heartburn and regurgitation. Conventional treatment typically involves lifestyle modifications such as tobacco cessation, exercise, and diet alternatives. The use of medications such as proton pump inhibitors (PPIs) and H2 receptor antagonists are not without their own adverse effects and risks of long-term use, such as increased gastric pH and vitamin and mineral deficiencies. Additionally, these medication may not be effective in diminishing symptoms in all patients. Prescribing chronic medication contributes to medication burden, which can lead to decreased adherence, polypharmacy, and increased cost. TIF is a minimally invasive procedure to treat GERD, with high rates of effectiveness.
Conclusions: TIF offers a promising alternative for patients with atypical or refractory GERD, providing symptomatic relief and improved quality of life without the need for long-term medication use. Unlike traditional surgical methods such as Nissen fundoplication, TIF is a less invasive approach, preserving the option for future interventions if necessary. This case demonstrates the efficacy of TIF in a patient that experiences years of GERD-related symptoms that were unresponsive to conventional therapies, such as lifestyle modifications and medication. The successful resolution of symptoms and normalization of acid exposure highlight the potential of TIF as a viable and effective treatment modality for GERD. Furthermore, additional research including larger cohorts and longer follow-up periods with larger cohorts and longer follow-up periods are warranted to establish the long-term benefits and safety profile of this approach.