I am pleased to share an innovative surgical solution for your patients with chronic acid reflux. The endoscopic TIF^® 2.0 procedure allows me to effectively treat the root cause of moderate to severe GERD and fills the treatment gap between pharmacological therapy and more traditional surgical options. 

TIF (Transoral Incisionless Fundoplication) is not new. More than 30,000 TIF procedures have been performed worldwide since 2007. Additionally, there are over 140 peer-reviewed publications in respected gastroenterology and surgical journals including four randomized controlled trials, two with sham control arms.

Many patients are diagnosed with GERD and not fully satisfied with their current treatment options. They often present with daily heartburn and regurgitation or other atypical symptoms such as chronic cough, hoarseness, chronic sinus or lung infections, and dental erosions. Until recently, patients only had two choices—a lifetime dependence on daily medications (and often incomplete symptom control), or the risks and long-term side-effects of traditional surgery.

PPI medications offer safe and effective short-term relief for heartburn symptoms. Unfortunately, even while on medications for years, many patients are still unable to eat the foods they want or must sleep sitting up to reduce nighttime reflux, and these patients frequently become dissatisfied with lifestyle adjustments.

TIF isn’t just a treatment option for the most severe cases that would have traditionally required a Nissen fundoplication; it has become a preferred solution for patients with moderate to severe GERD.  Additionally, TIF is designed to treat GERD symptoms while minimizing post-operative side effects such as dysphagia, gas bloat, and flatulence.

The TIF procedure is a data-backed solution for moderate to severe GERD patients who are:

• Dissatisfied with pharmaceutical therapies and the burdensome lifestyle changes (sleeping positions, strictly timed eating, etc.) that they are forced to manage symptoms
• Suffering from non-acid symptoms of reflux such as asthma, persistent cough or sore throat
• Dissatisfied with progressively increasing dosages of their reflux medications that may or may not be controlling symptoms
• Concerned about the potential long-term side effects from dependence on proton pump inhibitors

Indications for the TIF procedure include patients presenting with a dysfunctional antireflux valve, including those with a hiatal hernia. For patients presenting with both GERD and a hiatal hernia, laparoscopic hiatal hernia repair may be performed immediately prior to the endoscopic TIF procedure in the same anesthesia setting.

I am available to answer questions any time. We can review specific patients in your practice who might be candidates for GERD interventions like the TIF procedure with or without hiatal hernia repair.  To schedule an evaluation for your patients, please call (603) 692-2228.

Thank you for your partnership in providing the most advanced care available for our patients. 

Sincerely,
Khushboo Munot, MD

Downloadable Version of Advancement in the treatment of GERD

Wentworth-Douglass Hospital performs groundbreaking procedure treating heartburn and similar conditions.

SOMERSWORTH, NH, March 2023—Certified physician assistant Haley Lydstone has joined Atlantic Digestive Specialists, the primary providers of gastroenterological services on the Seacoast of NH, Maine, and Massachusetts.

Haley earned her master’s degree in physician assistant studies from the Massachusetts College of Pharmacy and Health Sciences in Manchester, NH. She went on to complete an immersive 54-week emergency medicine fellowship program at Merrimack Valley Emergency Associates.

Haley has most recently worked as a physician assistant at Lowell General Hospital in Massachusetts.

She joins the Atlantic Digestive Specialiats office in Somersworth, NH.

Dr. Geoffrey Clark founded Gastroenterology Professional Associates (now Atlantic Digestive
Specialists) forty-seven years ago as the first gastroenterology medical practice in the Seacoast
area. The foundation that he established in 1976 led to our growth as one of the premiere
digestive specialty practices in New England today.

Dr. Clark strongly advocated for improving clinical outcomes by putting the patient’s needs first and foremost. He never wavered from that objective. Dr. Clark was an honest and kind individual with many diverse interests and achievements. We valued and enjoyed each moment we shared with him over the past seventeen years since his retirement and will always be thankful to him for putting this exceptional practice together. We will miss him dearly. His passing has received much media attention. Below is one of those articles.

Portsmouth Philanthropist, Physician and Entrepreneur – Dr. Geoffrey Clark Has Died
By PAULA TRACY, InDepthNH.org

PORTSMOUTH – Philanthropist, entrepreneur, and Portsmouth gastroenterologist,
Dr. Geoffrey E. Clark has died. Born May 21, 1938, Dr. Clark was 84 years old.
Together with his wife, former state Sen. Martha Fuller Clark, D-Portsmouth, the two
have been recognized as a formidable team for more than 45 years helping New
Hampshire’s vulnerable communities, particularly children, women, and the
environment.

Ray Buckley, chairman of the New Hampshire Democratic party, called Dr. Clark a
“beloved” community leader, philanthropist, and husband.

“Dr. Clark was one of the most interesting, kindest, most generous people I’ve ever
met. He’s well-respected and accomplished in a variety of fields, and he will forever
be remembered in New Hampshire.

“He’s left an ever-lasting mark on the Granite State, in the political world, and far, far
beyond. My heart goes out to Senator Martha Fuller Clark, his beloved wife — Caleb,
Anna, and Than, his children he loved dearly — and his four grandchildren, who were
the lights of his life,” Buckley said.

The Clarks moved to Portsmouth in 1973 and served on more than 40 boards over
the years.

They have both been very involved with New Hampshire politics, with Martha Fuller
Clark serving six terms in the New Hampshire State Senate. Martha Fuller Clark is
currently serving as vice chair of the New Hampshire Democratic Party.

Dr. Clark served for more than 32 years as a doctor at Gastroenterology Professional
Association. He was also co-founder and first medical director of Braintree
Laboratories Inc. and was medical director at the pharmaceutical developer
Ischemix, working to find treatments for heart and kidney disease.

Dr. Thomas Sherman of Rye, a former state senator and retired gastroenterologist
who also ran for governor, said: “I will always remember Geoff for his wonderful
friendship and as a fellow gastroenterologist, for his remarkable accomplishments in
science and medicine.

“Not only was he a respected and compassionate physician, but his work in science
has changed healthcare, benefiting millions of people across the globe. A man of
gentle humility, he will be deeply missed,” Sherman said.

Dr. Clark was also involved in documentary filmmaking, including “Abandoned in the
Arctic,” which re-traced the efforts of an explorer in 1881-1884 by sea kayak 700
miles from the North Pole.

He also was involved in Sustainable Harvest International, which works to promote
the preservation of important world habitats.

Dr. Clark volunteered with Theatre of the Seas, which became the Seacoast
Repertory Theatre, by helping to strike the sets and later became involved as a board
member and led the capital fund drive “to encourage people to step up to the plate
and make important things happen,” he said in an interview published in the New
Hampshire Business Review.

“It was a trial by fire to find people, and the money we raised was small today but
very big dollars then. I was happy to write a check, and I learned it’s one thing to ask
people for money but another to ask them to become involved. It was a challenge to
expand the base of people who have the means to contribute and then to keep them
involved and see the benefits,” Dr. Clark said during the interview.

When asked what public service meant to him, he told NHBR:  “I think one thing: It’s
a lot of fun. It can be frustrating because you don’t always get what you want, but
it’s terrific to help manage important institutions and have a big influence in so many
areas. I’ve never regretted a contribution I’ve made.”

Congresswoman Annie Kuster, D-NH, said his contributions will be missed, that New
Hampshire lost a giant in Dr. Clark’s passing.

“Dr. Geoffrey Clark was a generous and thoughtful friend, always working to help
others. For decades, he made a positive and long-lasting impact on communities all
across our state. My thoughts and prayers are with his family and loved ones,”
Kuster said.

Portsmouth Mayor Deaglan McEachern said: “Portsmouth lost a leader on Saturday.
Geoff worked tirelessly to make life in our community better. His loss is
immeasurable and on behalf of the City of Portsmouth we send our condolences to
his beloved wife Martha and their children Caleb, Anna and Than.”
In 2019, the New Hampshire Women’s Foundation honored the Clarks for their
commitment to women and girls in New Hampshire.

The foundation presented the couple with its AmplifiHER Award, citing the Clarks for
more than 40 years of “dedicating their personal and professional lives to
strengthening New Hampshire communities,” according to NHBR.

Funeral arrangements were not immediately available.

Acid reflux is the most common digestive disorder. The valve which prevents the backflow of acid from the stomach into the esophagus (food pipe) is made of diaphragm and muscles at the junction of esophagus and stomach. When this valve mechanism does not function due to either hiatal hernia or intrinsic valve dysfunction, it leads to reflux of acid in the esophagus. Hiatal hernia occurs when a part of the stomach moves up in the chest from the abdomen. 

Dr. Munot now performs TIF (and c-TIF*), a new state-of-the-art minimally invasive procedure and does not require any incision. 

It is an acronym for Transoral Incisionless Fundoplication (TIF). During the procedure an endoscope ( a long tube with camera at the end) is advanced into the stomach to examine the valve internally. A special device designed to perform the valve repair and FDA approved is introduced into the stomach over the endoscope. The device then augments and repairs the valve by pulling the esophageal tissue into the stomach and then wrapping the stomach creating a 270 degree wrap. If there is additional hiatal hernia on exam it combines laparoscopic hiatal hernia repair with restoration of the faulty valve so that food and liquids no longer move back up into the esophagus once ingested. This procedure makes it no longer necessary to have a major open surgery with negative side effects like inability to belch or vomit, trouble swallowing and bloating.

A study in the Journal of the American College of Surgeons last year stated that patients with c-TIF experienced:

73% decrease in acid reflux frequency and severity

83% decrease in regurgitation

89% reduction in proton pump inhibitor use

When diet, lifestyle changes and use of proton pump inhibitors and other medications bring no relief or you want to get off these medications long term- you may want to consider the safe and effective options available like TIF or c-TIF.

*concomitant Transoral Incisionless Fundoplication

The Affordable Care Act (ACA) helped make preventive care recommendations by the US

Preventive Services Task Force, in particular colorectal cancer screening, more affordable and accessible for millions of Americans.

It is estimated that there was an increase of 8,400 (8%) in diagnoses of early-stage colorectal cancer among seniors between 2011 and 2013 due to the decrease in out-of-pocket costs for initial screenings, as Medicare was required to cover such costs without any patient cost-sharing.

In addition to being one of the most prevalent cancers in the United States, technology

allows the greatest chance of colorectal cancer detection at an early and treatable

stage. Colonoscopy screening for colorectal cancer has received an “A” rating from the

task force, meaning that colonoscopies provide a definite health benefit.