AllMed Webinar Aids Health Plans In Understanding When The LINX Reflux Management System Is Medically Necessary

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The LINX Reflux Management System was approved as a minimally invasive alternative to fundoplication, which has long been the surgical gold standard for patients with GERD not responsive to medical therapy. Many health plans, however, still consider the LINX device experimental and investigational for the management of GERD.  “But this may change,” according to Dr. Joseph Feuerstein. During a recent AllMed Healthcare webinar, Dr. Feuerstein, who is board-certified in Internal Medicine and Gastroenterology, discussed the latest issues related to treating gastroesophageal reflux disease (GERD), including determining medical necessity of the LINX Reflux Management System. 

In his overview of the disease, Dr. Feuerstein said that the main cause of GERD is incompetence of the lower esophageal sphincter (LES) and other anti-reflux barriers at the esophagogastric junction. He added, “Progressive disease results from the vicious cycle in which esophageal mucosal inflammation affects nerves and muscle that alter LES function and esophageal body motility.”

Diagnostic studies used to evaluate patients with suspected GERD include upper gastrointestinal (GI) endoscopy/esophagogastroduodenoscopy, ambulatory 24-hour pH monitoring, and 24-hour pH impedance testing. After describing each of these studies, Dr. Feuerstein noted that upper GI contrast-enhanced studies are the initial radiologic procedure of choice for patients with suspected GERD. Before reviewing treatment options for GERD, Dr. Feuerstein explained that treatment of GERD involves a stepwise approach based on lifestyle modification and control of gastric acid secretion with medications or surgical treatment. He stressed that surgery for GERD is usually a last resort, when other treatments have failed to relieve symptoms. There are a number of surgical options that may help to relieve GERD symptoms and manage complications. Currently, fundoplication is the standard surgical treatment for GERD.

The LINX device mechanically augments the function of the LES for the treatment of GERD. It is indicated for patients diagnosed with GERD as defined by abnormal pH testing, and who continue to have chronic GERD symptoms despite maximum medical therapy for the treatment of reflux. Dr. Feuerstein discussed the potential adverse events associated with the LINX system, some of which may require explantation and/or replacement of the device.

The American College of Gastroenterology (ACG) and the American Gastroenterological Association (AGA) have each developed practice parameters and guidelines for the surgical treatment of GERD. Dr. Feuerstein summarized the recommendations made by these organizations. In general, surgical treatment of GERD is a viable option for carefully selected patients who have not responded to conservative treatment.

While fundoplication is still the go-to treatment, Dr. Feuerstein indicated that it’s possible the LINX device will become a more common solution as long-term safety and efficacy data on the device become available. With this in mind it is essential for healthcare plans to position themselves to be able to make timely updates to their coverage criteria and medical policies in order to optimize care and treatment outcomes. 

To view the recording of this presentation click here.

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