Transcutaneous electrical stimulation may reduce esophageal acid exposure by 74.5% and significantly decrease gastroesophageal reflux disease symptoms, according to a recent study.
In the prospective, multicenter study, published in Neurogastroenterology & Motility, researchers conducted an uncontrolled feasibility study to evaluate the effects of a transcutaneous electrical stimulation system (TESS) on gastroesophageal reflux disease (GERD) symptoms and esophageal acid exposure time (AET). The researchers, led by Ram Dickman of Division of Gastroenterology at the Rabin Medical Center at the Beilinson Campus in Petah Tikva, Israel, and colleagues, aimed to assess whether TESS could serve as a noninvasive alternative among patients with GERD who experience suboptimal responses to proton pump inhibitors (PPIs). Given the high failure rate of PPIs and the limited adoption of invasive surgical interventions such as laparoscopic fundoplication, alternative therapies remain an area of clinical interest.
The researchers enrolled 31 adult patients with persistent GERD symptoms, defined as heartburn and/or regurgitation occurring more than 3 days per week for at least 3 months. The study design included a 1-week run-in period off PPIs, during which participants recorded symptom frequency and severity using a smartphone application. All patients subsequently underwent wireless 96-hour esophageal pH monitoring. Only those with pathological AET, defined as total time with esophageal pH less than 4 exceeding 6%, proceeded to the treatment phase, where they used TESS for 17 days.
Among the 26 patients who completed the study (42% female, mean age = 49 ± 15 years, mean body mass index = 25 ± 3 kg/m²), TESS treatment significantly reduced GERD symptoms. The mean daily number of heartburn episodes decreased from 2.55 ± 1.79 at baseline to 0.77 ± 0.75 posttreatment (P < .001), whereas regurgitation episodes declined from 1.40 ± 1.73 to 0.36 ± 0.80 (P < .001). Esophageal acid exposure was also significantly reduced, with mean AET decreasing from 12.4 ± 5.6% to 6.0 ± 3.5% (P < .001) and the DeMeester score dropping from 32.1 ± 12.7 to 16.2 ± 8.2 (P < .001).
The mean reduction in esophageal acid exposure was 74.5% (standard deviation [SD] = 31.9%), and the DeMeester score decreased by 82.3% (SD = 26.8%). TESS was well tolerated, with no severe adverse events reported. Mild erythema or itching at electrode sites was observed in 26% of patients but resolved without intervention. The study found that TESS significantly reduced GERD symptoms and esophageal acid exposure. The researchers emphasized the need for larger, sham-controlled studies to confirm efficacy and further investigate the mechanism of action.
Full disclosures can be found in the published study.
