Transcutaneous electrical stimulation beneficial in refractory GERD

Transcutaneous electrical stimulation system (TESS) is safe and has the potential to reduce oesophageal-acid exposure in patients with gastro-oesophageal reflux disease (GERD) unresponsive to proton pump inhibitor (PPI), as shown in a study.

As a noninvasive device, it integrates a piezoelectric breathing sensor for synchronizing the stimulation pulses with the patient's breathing phase. The system works by stimulating the abdominal muscles with modulated asymmetrical biphasic current waveforms (sawtooth wave) with a typical controlled current level of 15–40 mA base to pick and maximum 70 mA.

The system was tested in 10 GERD patients who had failed treatment with standard-dose PPI. All of them had heartburn complaints and regurgitation with an abnormal oesophageal-acid exposure (off PPIs). TESS was performed after the placement of a wireless oesophageal pH capsule.

All patients had a normal upper endoscopy while on standard-dose PPI. Their mean age was 49.1 years, and 71 percent were female. The mean duration of symptoms was 4 years.

Of the patients, only seven (five females and two males) completed the study. Following treatment with TESS, the mean percent total time pH <4 dropped from 12.0±4.9 at baseline to 5.5±3.4 at day 1, 4.5±2.6 at day 2, 3.7±2.9 at day 3, and 4.4±2.5 at day 4.

Furthermore, the mean DeMeester score decreased from 39.0±18.5 at baseline to 15.8±9.2 at day 1, 13.2±6.8 at day 2, 11.2±9.4 at day 3, and 12.0±6.8 at day 4.

The present data provide justification for performing a larger controlled clinical trial to verify the efficacy of TESS and explore its mechanism of action.