Technologies/Companies to watch ...

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aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 6/10/2011 7:02 PM (GMT -6)   
I've been doing research on new ideas, technologies, companies in the anti-reflux area and here is the exhaustive list so far ..
- Endostim (neurostimulator)
- BARRX Medical (barretts ablation)
- EndoGastric Solutions (esophyx)
- Enteric Medical (enteryx) << THIS ONE WAS TAKEN OUT
- Medigus (sort of like esophyx)
- Torax Medical (Linx) << WE ALL KNOW about THIS

Endostim claims to have run some clinical trials in India and Chile .. seems quite promising to me .. if it can work .. stimulating the nerves to get the LES muscle to close.. wow!

Could this be for real?

From one of the press articles:

Press Article said...

For now, EndoStim is using a pacemakerlike device that is being tested on patients in India and Chile. It is similar to a pacemaker used by cardiac patients. The company is working with engineers in Seattle and consultants in Uruguay to build a smaller, implantable device that can be inserted in the muscle via a long tube.

Sharma, who also owns a gastroenterology practice in Gilbert, said early results from the international clinical trials showed the device was safe and effective. The company plans to launch clinical trials in Europe before the end of this year and begin negotiations with the Food and Drug Administration in mid-2011 for clinical trials in the United States.



Jeronimo
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Date Joined Apr 2011
Total Posts : 76
   Posted 6/10/2011 8:01 PM (GMT -6)   
Wow, clinical trials before the end of this year in Europe!!??? YES PLEASE!!!

Could you pass me the direct link to that article? I didnt know they would start with clinical trials in Europe!

Ive known about them for some time and I think this could be the 100% rock solid solution for all of us!

aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 6/10/2011 8:11 PM (GMT -6)   
These were the press articles I was able to google:


www.azcentral.com/business/articles/2010/11/23/20101123biz-endostim1124.html

www.prweb.com/releases/2010/11_AzTE_EndoStim/prweb4830914.htm

Post Edited (PPI-LESS) : 6/10/2011 7:52:54 PM (GMT-6)


Jeronimo
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Date Joined Apr 2011
Total Posts : 76
   Posted 6/10/2011 8:17 PM (GMT -6)   
Thanks!

I already knew about the azcentral article. I knew about the ones they were doing that year , 2010, I thought you ment 2011, thats why I was suprised!

Anyways, lets hope we know something soon about it being available to everyone! Ill do some reasearch to see if I can find someone thats part of the trials.

Jeronimo
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Date Joined Apr 2011
Total Posts : 76
   Posted 6/10/2011 8:33 PM (GMT -6)   
Ive just done some quick research in spanish and the company from Uruguay that EndoStim is working with is CCC, a company specialized in pacemaker devices:

www.ccc.com.uy/index.htm

aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 6/10/2011 8:34 PM (GMT -6)   
That article came out in November and those are the time-frames they are quoting from that time .. I wonder if things fizzled out or otherwise we would've heard more about it by now ...

I wonder how this device would operate though .. if the current device is anything like a pacemaker then it'll probably sit outside and be connected to the LES somehow from some incision or something? Seems kind of impractical for the long run though ..

aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 6/10/2011 9:57 PM (GMT -6)   
You know .. I won't blink an eyelid to install even a pacemaker like device into my body to get rid of this idiotic condition ...

Jeronimo
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Date Joined Apr 2011
Total Posts : 76
   Posted 6/10/2011 10:36 PM (GMT -6)   
AZCentral Article said...
Arizona State University engineering professor Bruce Towe helped create the technology, which includes a microchip that is so tiny that it can fit through a syringe.

For now, EndoStim is using a pacemakerlike device that is being tested on patients in India and Chile. It is similar to a pacemaker used by cardiac patients. The company is working with engineers in Seattle and consultants in Uruguay to build a smaller, implantable device that can be inserted in the muscle via a long tube.


What I understand is that for now they are using a pacemakerlike device but what they really want to achieve is a small device that can be implanted INTO the LES. Sounds good to me, I mean...you are making the LES work as it should with a little help. No stomach anatomy modification that you get with the Nissen and I bet the device can be removed if necessary

I just hope this device ends up being a total succes! Hope! :-)

aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 6/10/2011 10:49 PM (GMT -6)   
Yeah .. I hope too .. but I don't think this "implantable" device is going to be available anytime soon .. the current trials are based on the pacemaker-like device - and I dont mind using the pacemaker for now ...

I just don't know what the performance / success is of this .. press releases can be so far from the realities ..

I always thought that the day after I die, they'll find a way for people to live forever .. and it seems to be somewhat like that here with my situation .. I think this stuff is long ways away from being anywhere close to reality .. or otherwise these guys would've jumped all over the place with this technology .. so I really don't have my hopes high ..

Jeronimo
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Date Joined Apr 2011
Total Posts : 76
   Posted 6/11/2011 8:47 AM (GMT -6)   
Well...I really dont know, ill keep searching for information but maybe the people that underwent the trials might have had to sign a contract or something that doesnt allow them to spread information about it on the net, Im just guessing!

Neptunian808
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Date Joined Dec 2010
Total Posts : 86
   Posted 6/11/2011 8:00 PM (GMT -6)   
"Endostim claims to have run some clinical trials in India and Chile ." lol what, im from Chile i didn't know anything about this.

Gilad
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Date Joined Jul 2009
Total Posts : 37
   Posted 10/18/2011 12:24 AM (GMT -6)   
This sound promising. I wonder though how it will work. The article says "The device works by electrically stimulating nerves that control the muscle, telling the muscle to contract and block acid discharges from the stomach."

But the muscle also needs to retract every couple of minutes in order to allow air and food or salaiva in and out of the stomach.

I feel like I want all these new procedures to be done to me at once. A biological graft for the hernia, Esophyx and Linx and to top it off this device as well. Just so long as I don't have to do the Nissen.

Gilad
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Date Joined Jul 2009
Total Posts : 37
   Posted 10/18/2011 9:41 AM (GMT -6)   
By the way, there is another possible future treatment option that should be added to the list above:
Muscle Cell Infusion

see here:
http://www.sciencedaily.com/releases/2009/12/091204145709.htm?utm_source=feedburner&utm_medium=%20feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceD%20aily%3A+Latest+Science+News%29

and here

http://www.medindia.net/news/Gastric-Reflux-may-be-Treated-by-Muscle-Cell-Infusion-61935-1.htm

aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 10/18/2011 1:18 PM (GMT -6)   
Thanks Gilad .. this indeed is quite interesting ... this is exactly the type of fundamental solution to these problems (at the cellular level) .. that the medical research should be working on ..

aciphexo
Regular Member


Date Joined Apr 2011
Total Posts : 377
   Posted 10/18/2011 8:19 PM (GMT -6)   
Similar to the above, there are "stem cell" related therapies that are worth exploring. I am not sure if these can solve the LES incompetency related problems or not ... but something the medical research community should continue to explore:

health.upenn.edu/news/news_releases/2008/12/esophagus-tissue-growth.html

flux
Regular Member


Date Joined May 2007
Total Posts : 28
   Posted 5/4/2012 9:28 AM (GMT -6)   
Endostim trials...
http://clinicaltrials.gov/ct2/show/NCT01578642
http://clinicaltrials.gov/ct2/show/NCT01574339

gerd_hater
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Date Joined Oct 2012
Total Posts : 322
   Posted 11/21/2012 9:36 AM (GMT -6)   
Thinking out aloud: I am imagining a microcontroller based future solution, kind of cross between LINX and EndoStim: press a button to loosen/tighten slightly as required.

This process could even be automatic - relax when food is detected and close when there has been no food for a minute or so.

flux
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Date Joined May 2007
Total Posts : 28
   Posted 11/21/2012 10:23 AM (GMT -6)   
This is essentially the way in which Endostim is presumed to work, automatically, in fact. How, if it is indeed the case, it does this is presently unknown.

gerd_hater
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Date Joined Oct 2012
Total Posts : 322
   Posted 11/22/2012 1:38 AM (GMT -6)   
Does the LES actually respond to stimulation in a predictable manner ? I thought this was the weak point of Endostim.

There are a few variables that make Endostim far from "polished" in my opinion. I would be happy to be wrong!
(1) LES pressure vs electrical stimulus tuning: each individual will have different profiles of LES pressure against stimulus
(2) Controlling one-way vs two-way valve: Does electrical simulation necessarily create a one-way valve? If it creates a two-way valve with a pressure controlled by the stimulation, there needs to be some "intelligence" in the stimulator.

flux
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Date Joined May 2007
Total Posts : 28
   Posted 11/22/2012 10:38 AM (GMT -6)   
My understanding is that the LES is a circular band of muscle that is continuously being stimulated to contract. During swallowing, gastric belching, vomiting and sometimes spontaneously the stimulation is inhibited and it relaxes. It is these spontaneous inhibitions that allow material to reflux backward (because gastric pressure is greater than the pressure of the distal esophageal lumen).

One would think that in order for a device like Endostim to work, it would have to stimulate contraction at precisely the times of the spontaneous relaxations; otherwise, it would interfere with the required relaxation during swallowing. However, when it was first studied in dogs, it turned out that stimulation did not impact the relaxation during swallowing. At the same time, it appeared to prevent reflux, thus suggesting that it is somehow automatically inhibiting the inhibitions of the spontaneous relaxations (although as far as I can tell, and strangely from my opinion, this hasn’t been formally measured).

It’s not clear what the role is for being able to alter the frequency/amplitude of the stimulation. In the published studies, they tried only two different paradigms and found that either one worked. Only one patient experienced discomfort, which disappeared when the frequency/amplitude was adjusted.

gerd_hater
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Date Joined Oct 2012
Total Posts : 322
   Posted 11/22/2012 11:07 AM (GMT -6)   
Seems logical, but it does beg a few questions.

I understand the dominant mechanism of GERD is TLESR (transient LES relaxation) and the other mechanism is hypotensive LES (the sphincter just does not provide any notable pressure).

(1) If Endostim works only by preventing TLESRs, what of hypotensive LES cases ? Is it that with stimulation there will no longer be a notion of "low pressure" at LES and reflux can happen only due to TLESRs ?

(2) Does it also mean that you cannot vomit/belch with Endostim ?

flux
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Date Joined May 2007
Total Posts : 28
   Posted 11/22/2012 12:40 PM (GMT -6)   
Endostim definitely increases the baseline pressure of the LES, but somehow it doesn't appear to stop the natural relaxations of the sphincter during vomiting or gastric belching.

One explanation may be the relaxation of the sphincter during swallowing, belching, vomiting is somehow physiologically different from relaxations during the spontaneous transient relaxations.

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 11/22/2012 1:21 PM (GMT -6)   
Wow, if this is true, it would be the perfect cure then, wouldn't it ?

May I ask what the source of your info is ? I remember reading some paper but don't recall having understood this fundamental claim that transient relaxations are of a different nature.

Based on your post, the mental model I have of an LES now is this:
(1) LES maintains a constant pressure except during TLESR
(2) During TLESR, the LES opens for a short while.
(3) Swallows, belches, vomits "forcefully" open the LES because of higher pressure (from above or below)

If this model is true, Endostim essentially works by maintaining the constant pressure because stimulation maintains constant pressure and inhibits spontaneous relaxations, which I'd think has a much higher chance of success and repeatability across patients

Post Edited (gerd_hater) : 11/22/2012 11:30:23 AM (GMT-7)


flux
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Date Joined May 2007
Total Posts : 28
   Posted 11/22/2012 3:03 PM (GMT -6)   
The LES naturally relaxes for swallowing, gastric belching and vomiting. Not having it relax is a disease called achalasia. I don't think there is any qualitative difference between that relaxation and the relaxation in spontaneous, transient relaxations. However, the trigger may involve a different mechanism. For example, it is probably the case that transient relaxations are triggered by the brain (via the vagus) whereas the others are local, but I'm not sure this is known for sure. If so, one way Endostim might be working is having the LES ignore the brain. We might have an answer to this question when current clinical trials are finished and the results published.

All the info comes from what I could find online, some of which is referenced elsewhere on this site. I think there have been five published studies, including one on dogs. In addition, the patent had been posted elsewhere on this site. Finally, I emailed them directly, though they haven't fully answered all my questions.

phil-uk
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Date Joined Jul 2012
Total Posts : 190
   Posted 11/22/2012 6:28 PM (GMT -6)   
Interesting conversation here, thanks.

This is the other Endostim thread on HW.

"Endostim New device for GERD/LPR"
http://www.healingwell.com/community/default.aspx?f=45&m=2438608

Endostim also gets mentioned on JPT's thread 'linx2' and Story went to see them in Holland. I think some new studies have results in March 2013.
cheers
phil
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