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Robert Permut, retired psychiatrist, didn’t have the classic symptoms of acid reflux, but he ended up being an ideal candidate for a new procedure offered at Silver Cross Hospital. It started almost eight years ago in 2010 when he had a persistent cough that didn’t seem to go away.

After tests revealed significant signs of reflux, he was referred to Dr. Kamran Ayub, board-certified gastroenterologist and Medical Director of the Advanced Endoscopy Center at Silver Cross Hospital.

Dr. Ayub prescribed medication that helped relieve the cough and treat the reflux. Dr. Permut took the medications for several years, however, the side effects were starting to affect his daily life.

“I didn’t want the open surgery to fix the issue. So I asked Dr. Ayub about the newer procedures that have come out and to see if I was a good candidate,” Dr. Permut said.

He ended up being an ideal candidate for the TIF procedure (transoral incisionless fundoplication). The procedure is done without making any incisions and is performed through the patient’s mouth.

The TIF procedure has become an established treatment, and Silver Cross recently acquired the latest technology, the EsophyX Z device. The EsophyX Z technology is used to reconstruct the anti-reflux valve between the esophagus and stomach, which opens and closes to allow food to pass into the stomach. It also acts as a barrier to acid in the stomach, preventing acid from getting into the throat and causing acid reflux.

Once patients are unable to control acid reflux symptoms on medications, like in Dr. Permut’s case, their only previous treatment option had been to consider traditional surgery performed laparoscopically with small incisions in the patient's abdomen.

The TIF procedure, similar to an endoscopy, is done through the mouth, which decreases recovery time. Dr. Ayub has been performing the TIF procedure since 2008.

"The TIF procedure is a great option for anyone with moderate to severe reflux,” he said. “Those who cannot tolerate anti-reflux medication, who are young, have side effects from these medications, or don’t want to take these medications for other reasons should consider the procedure."

It wasn’t until he had an acid reflux test done in preparation for the procedure that Dr. Permut experienced severe heartburn.

“I had to go off the medications for the test, and that’s when the heartburn was incredibly severe,” he said. However, once the procedure was complete on March 6, the heartburn was gone.

Dr. Permut is completely off one of the medications he had been on, and hopes to be off the other medication sometime in May. He also no longer has any restrictions in his diet.

“By and large, I’ve been great since the procedure,” he said. “I know most people who have this will focus on the heartburn, but for me it was getting rid of the persistent cough.”


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Physicians on Silver Cross Hospital’s Medical Staff have expertise in their areas of practice to meet the needs of patients seeking their care.  These physicians are independent practitioners on the Medical Staff and are not the agents or employees of Silver Cross Hospital. They treat patients based upon their independent medical judgment and they bill patients separately for their services.