Imagine not being able to eat or drink without pain, nausea, or vomiting. That’s the reality for people with a condition known as achalasia. Now, there’s a new procedure to fix the problem and there is no incision required!
Today, Terri Conley savors every bite of food. Not long ago, she wasn’t able to swallow without pain.
“It’s like wow, I can’t eat. I really can’t eat,” Terri told Ivanhoe.
Terri lost 86 pounds, was malnourished, and had no energy to perform her job as a dental hygienist.
“I went to the doctor, and they said, ‘Oh, you know, take some Prilosec and get the stress out of your life,’” Teri explained.
However, another doctor and an ultrasound revealed Terri had achalasia—a condition where the base of the esophagus doesn’t relax, so food can’t pass through to the stomach. The result is pain and vomiting.
“In really severe cases, they can’t even take liquids or swallow their own saliva,” Michael M. Awad, MD, PhD, FACS, Director, Washington University Institute for Surgical Education (WISE), Washington University School of Medicine in St. Louis, told Ivanhoe.
Doctors at Washington University are performing a new procedure to fix the problem. They enter through the patient’s mouth and make a small incision on the lining of the esophagus, cut the muscle in the lower esophagus to help it relax, allowing food to pass through.
“Since there’s no pain fibers in the GI tract, people don’t feel this,” Faris M. Murad, MD, Interventional Endoscopist, Director of Endoscopic Ultrasound, Washington University School of Medicine, St. Louis Children's Hospital, told Ivanhoe.
Now, Terri can eat what she wants.
“When I finally got to eat what I wanted to eat, I wanted to make chicken enchiladas. That was the one big thing,” Terri said.
This procedure was first performed in japan. To date, there have been a little more than 400 incisionless procedures worldwide for achalasia. About one in 10 thousand people have this condition. Doctors don’t know what causes it, but some have theorized that it may be triggered by a virus.
BACKGROUND: Achalasia is a disorder that prevents people from eating and drinking. The disorder takes place in the esophagus and does not allow food to pass into the stomach. The esophagus is compromised and is no longer available to transfer food to the appropriate organs. This happens due to damage done to the nerves in the esophagus and is not curable. (Source: http://www.mayoclinic.org/achalasia/)
CAUSES: Doctors do not know the exact cause of achalasia, but they believe that it stems from a virus. Cancer in the upper stomach, or esophagus, as well as a parasite infection can also cause achalasia. This disorder is very rare and can occur at any age. Achalasia is more common in older or middle-aged adults, and it can be inherited. (http://www.nlm.nih.gov/medlineplus/ency/article/000267.htm)
SYMPTOMS: First, symptoms are mild, and then grow worse.Common symptoms of achalasia are:
- Coughing while lying down
- Chest pain
- Trouble swallowing
- Weight loss
- Aspiration (Source:
NEW PROCEDURE: There are different ways to treat achalasia, but most of the treatments include surgery. Now, doctors can perform a minimally invasive surgery to help patients with achalasia. This is one of the first of its kind in the region performed through a natural opening in the body rather than an incision. “When we swallow, it’s important that foods and liquids move through the esophagus into the stomach,” Dr. Faris M. Murad, was quoted as saying. “Patients with achalasia develop chest pain, and sometimes the problems are so severe that patients get liquid in their lungs, causing pneumonia. But the main difficulty is that food and liquids tend to fill the esophagus and then are regurgitated.” Some patients get treated with drugs or with a procedure that involves inflating a balloon to stretch the opening between the stomach and the esophagus. About half receive laparoscopic surgery, which involves many keyhole incisions in the chest and abdomen. The new procedure was first performed in Japan and is part of a trend to make surgery increasingly less invasive. (Source: http://news.wustl.edu/news/Pages/25737.aspx)
Michael M. Awad, MD, PhD, FACS, Associate Dean, Medical Student Education, Program Director, General Surgery, Director, Washington University Institute for Surgical Education (WISE), Washington University School of Medicine, talks about a new procedure for achalasia.
Achalasia, what is it?
Dr. Awad: Achalasia is a somewhat unusual disorder. It’s a swallowing disorder that affects about one in one hundred thousand patients a year. It’s a little bit unknown as to what the cause is and it affects people of all ages, of all backgrounds. The root of the problem is Normally, the sphincter between the esophagus and the stomach is closed but opens to allow food to pass through. In patients with achalasia, the sphincter doesn’t relax properly.
It doesn’t push the food down into the stomach, is that what it is?
Dr. Awad: That’s right. When people swallow the food hits that sphincter and it stops there, and then they have chest pain, the food comes up, they have nausea and vomiting. Initially it’s to really tough foods like steak and breads however over time it progresses to even soft foods and in really severe cases they can’t even take liquids or swallow their own saliva.