Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux disease.

BACKGROUND/AIMS: Radiofrequency treatment of the gastroesophageal junction using the Stretta procedure for treating gastroesophageal reflux disease (GERD) is observed to improve the symptoms and proton pump inhibitor (PPI) dependence and reduce the need for anti-reflux operations. As one of the largest studies in Europe, we evaluated the clinical outcomes of Stretta in patients with medically refractory GERD. METHODS: A tertiary UK center evaluated all patients with refractory GERD who underwent Stretta between 2014 and 2022. Patients and primary care professionals were contacted to obtain information regarding the initiation of PPI and reintervention after Stretta. RESULTS: Of the 195 patients (median age, 55 years; 116 women [59.5%]) who underwent Stretta, PPI-free period (PFP) data were available for 144 (73.8%) patients. Overall, 66 patients (45.8%) did not receive PPI after a median follow-up of 55 months. Six patients (3.1%) underwent further interventions. The median PFP after Stretta was 41 months. There was a significant negative correlation between PFP and age (p=0.007), with no differences between sexes (p=0.96). Patients younger than 55 years of age had a longer PFP than their older counterparts (p=0.005). Younger males had a significantly longer PFP than older males (p=0.021). However, this was not observed in the female cohort (p=0.09) or between the younger men and women (p=0.66). CONCLUSION: Our findings suggest that Stretta is a safe and feasible option for treating refractory GERD, especially in younger patients. It prevents further anti-reflux interventions in most patients and increases the lead-time to surgery in patients with refractory GERD.

Accessing the curriculum; university based learning experiences of visually impaired physiotherapy students.

The aim of this study was to explore the learning experiences of visually impaired physiotherapy students in the UK, specifically focusing on barriers and enablers faced within university and classroom based education. A qualitative multiple case study design was used due to the unique and small group of participants under exploration. Course Leaders of all universities in the UK that offered Physiotherapy education at undergraduate or pre-registration level were approached as gatekeepers to access participants. Four visually impaired physiotherapy students consented to take part in the study, each from a different institution. Semi-structured interviews were used at a time and setting chosen by each participant. Data were recorded and transcribed verbatim, and analysed thematically using NVivo 10. Both barriers and enablers were identified, with sub-themes within the data; the barriers were: environmental factors, unsupportive behaviours and time and effort. The enablers were: supportive relationships, student attributes, and strategies and adaptations. All participants experienced barriers to learning within their university setting, despite having disclosed a disability and having access to and provision of reasonable adjustments. However, despite facing barriers, there were many positive experiences that enabled learning, particularly when staff and students worked together in an open, supportive, and proactive environment.