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Peroral Endoscopic Myotomy (POEM)

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Peroral Endoscopic Myotomy (POEM)

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Overview

Achalasia is a rare disorder that affects the food pipe (esophagus), where the muscles at the lower end of the food pipe are constricted. This makes it difficult for the swallowed food to enter the stomach, causing regurgitation of the food back into the mouth. Only liquids can pass through the constricted food pipe in Achalasia. The symptoms of achalasia appear gradually and worsen with time. Timely diagnosis and the right kind of treatment in Bangalore ensure it is possible to manage the symptoms of achalasia and lead a good life.
 

What Is Achalasia?

The food that we chew is pushed into the esophagus after being swallowed. There is a muscular ring called the Lower Esophageal Sphincter at the lower end of the esophagus, where it connects to the stomach. When food approaches this sphincter, it relaxes and opens, allowing food to travel into the stomach. After the food has been consumed, it shrinks and closes. In Achalasia, the sphincter does not open; the food cannot reach the stomach and remain in the esophagus. It becomes challenging for the esophagus to push food down because its muscles are also impaired.

People with achalasia often fall into the 30 to 60-year age range. Men experience this disease two times more frequently than women.

What Are The Causes Of Achalasia?

Though it is well-established that achalasia happens due to the inability of the esophageal sphincter to relax, it is not known what exactly causes it. Several theories are put forth by scientists.

  • Nerve Degeneration- One of the theories suggests that the nerves along the esophageal wall start degenerating. This makes the esophagus unable to push the food down toward the stomach. But why these nerves start degenerating remains unknown.
  • Infections- Achalasia has a link with parasitic and viral infections. There are records of several achalasia patients having had a history of parasitic or viral infections. Antibodies to human papillomavirus, measles, herpes simplex virus, and others are found in the blood of people suffering from achalasia.
  • Autoimmune Theory- Achalasia is also postulated to be of an autoimmune origin. This theory is supported by evidence that people suffering from achalasia are 3.6 times more likely to suffer from autoimmune diseases like rheumatoid arthritis, diabetes mellitus type 2, uveitis, systemic lupus erythematosus, etc.

What Are The Symptoms Of Achalasia?

The symptoms of achalasia are mainly due to food piling up inside the esophagus. The piled-up food distorts the shape of the esophagus and widens it. This leads to abnormal contractions of the esophagus, resulting in different symptoms. The symptoms occur while eating or after you have finished eating. They include-

  • Dysphagia ( difficulty in swallowing). There is a sensation as if the swallowed food is sticking somewhere in the middle of its path toward the stomach. This is the most commonly reported symptom.
  • Regurgitation- The food or drink swallowed often returns to your mouth. 
  • Chest Pain- The chest pain in achalasia can be very severe, sometimes even waking up the person from sleep.
  • Heartburn- Burning sensation in the throat and chest.
  • Coughing-this happens mostly at night.
  • Weight loss- This occurs due to the inability to eat or drink anything, thereby causing malnutrition, weight loss, and fatigue.
  • Food Aspiration- The swallowed food may get into the windpipe (trachea) and cause choking. If it reaches the lungs, serious complications like pneumonia may occur.

How Is Achalasia Diagnosed?

A thorough medical examination, including your personal and family history, will help your doctor establish a diagnosis. He may suggest the following tests for confirmation-

  • Manometry- This is considered the gold standard test for diagnosing achalasia. This test tests the strength of the contractions of the esophageal muscles and the relaxation of the sphincter.  It is considered a positive test if no contractions are along the esophageal wall and the sphincter fails to contract in response to food.
  •  Barium Swallow- You will be made to swallow a liquid of barium preparation. The flow of this liquid is monitored through X-rays, and any obstruction to its flow at the lower esophageal junction confirms the presence of the contracted esophageal sphincter.
  • Upper Endoscopy- In this test, a narrow tube (endoscope) with a camera fixed on it, is inserted into your food pipe. This allows the doctor to visualize the interiors of the esophagus and look for any contraction of the sphincter.

What Are The Treatment Measures For Achalasia?

The treatment options available for Achalasia aim to improve the motility of food through the esophagus. You may need repeated sessions of some form of treatment. The treatments relieve the symptoms to a great extent but do not cure you completely. Treatment options include:

Non-surgical

Pneumatic Dilation- The esophageal sphincter is first dilated with a unique procedure, after which a specific bowl is introduced. Because of this, food can travel easily into the stomach and widens the lower esophageal aperture. Perforation, a rare danger associated with this medication, may occur and necessitate surgery in Bangalore.
Botox Injections- Injections of botulinum toxin are used in this technique. This poison works by inhibiting the neurons that contract the sphincter. By keeping the sphincter relaxed and dilated, food can pass through. Botox injections have quick but transient responses. You may need to schedule more sessions every six months to a year.
Medication- Certain medications can be tried when surgery is to be avoided. The medicines act in various ways to help the esophageal sphincter to relax. These medicines include-

  • Nitrates
  • Calcium channel blockers
  • Sildenafil

Surgical- This procedure is known as Laparoscopic Surgical Myotomy. In this procedure, the lower esophageal sphincter muscles are cut to relax and allow the food to pass. This surgery is done under general anesthesia. It is a minimally invasive procedure done using laparoscopes or robotic techniques.
This surgery has a high success rate.

What Are The Complications Of Achalasia?

The complications of achalasia are mainly due to the regurgitated food being aspirated into the trachea and lungs. The complications include:

  • Pneumonia (inflammation of the air sacs present in the lungs)
  • Lung infections

Suffering from achalasia increases your risk of developing esophageal cancer. 

How To Prevent Achalasia?

Achalasia is a lifelong condition that has no cure. Understanding the disease condition fully is important to set realistic expectations for living with achalasia. Lifestyle modifications help to control the symptoms of achalasia and can slow down their progress. Some of the lifestyle changes that you can incorporate include-

  • Keep a careful watch on what foods aggravate you more and avoid them from your diet altogether. Foods like alcohol, meat, raw fruits, and veggies, citrus foods are known to increase the symptoms of achalasia.
  • Cut your food into tiny bite-sized portions. The smaller the size of the food, the easier it will be for it to pass through.
  • Eat in an upright position. Often, gravity plays a role in getting the food down to the stomach.
  • Always keep your head elevated while sleeping. Laying down flat increases the chances of regurgitation and heartburn.

Why Choose MedFin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin! 

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