New Technique Cures Rare Swallowing Disorder

Umesh Isalkar

For nine months, Suresh (28) could not swallow food. If he tried too hard, the food would get stuck in his food pipe and he would have to throw up. When examined, doctors diagnosed him with achalasia cardia, a condition where the food pipe muscles thicken and do not relax after swallowing.

Patients suffering from the condition cannot swallow food, sometimes not even water or their own saliva. The condition can also cause reflux, chest pain and eventually cancer of the food pipe, oesophageal cancer, doctors say.

Mumbai-based gastroenterologist Amit Maydeo performed a minimally invasive surgery, Peroral Endoscopic Myotomy (POEM), to treat Suresh’s condition at the 15th Annual Conference of Society of Gastrointestinal Endoscopists of India that concluded in Pune on March 16. After a gap of nine months, Suresh could finally start eating slowly without any difficulty.

“Achalasia can manifest from a young age of around 5-6 years to around 70 years of age. Younger the patient, tighter is the achalasia,” said Maydeo.

The exact incidence of achalasia cardia is not properly studied in India, but conservative estimates indicate an incidence of around 2.5 in a 1lakh population. But seen from treating doctors’ experience, the incidence seems to be higher.

Doctors say the condition is not related to any food or lifestyle. “It occurs because of degeneration of the nerve plexus (branching network of intersecting nerves) around the oesophagus (food pipe) thereby causing inadequate relaxation of the lower oesophageal sphincter (bundle of muscles) after eating. The food therefore remains in the food pipe itself. If this continues for a long time, it can lead to oesophageal cancer,” Maydeo said.

Elaborating, how POEM has an edge over traditional surgical methods, Maydeo said, “Achalasia has been traditionally treated by a laparoscopic myotomy surgery, which usually stretches for two hours and around six small incisions are made in the stomach. Balloon dilatation has been another method to treat these patients but the procedure is associated with an uncontrolled rupture of the muscle fibres and is therefore considered dangerous.”

“The new technique, POEM, is a virtually non-invasive as no external cut is made on the body. The average blood loss is less than 5 ml. The patient’s recovery is remarkable and patient is able to talk and walk from the next day itself and can start eating food after one week,” said Maydeo who performed India’s first incision free POEM on a 54-year-old woman diagnosed with achalasia cardia in September 2012. The woman had been suffering from the condition for two years.

Maydeo has performed 103 procedures over the past 17 months in Mumbai.

Since the procedure was invented in 2007, its long-term results are not yet known. “However, the result has been good with patients treated so far. Almost all the patients have been relieved of the difficulty in swallowing,” Maydeo said.

As many as 30 patients have undergone POEM in Pune in the last two years (since December 2012). Deenanath Mangeshkar Hospital is the only centre in Pune that performs this procedure.

“The youngest patient to undergo POEM in Pune is 12 and the oldest 70. The procedure is therefore considered safe for all age groups,” said city-based gastroenterologist and interventional endoscopist Amol Bapaye, who claims to be the only doctor in Pune who performs POEM.

Since there is no cause, its prevention is not really feasible. Bapaye said, “Most patients with achalasia cardia are idiopathic in origin, which means there is no obvious detectable cause for the disorder. Since there is no cause, there are no preventive measures for the disease. No genetic or hereditary predisposition has been detected.”

Outside Maharashtra, few cases of POEM have been reported from Hyderabad, Surat, Kochi and Coimbatore, Bapaye said.

Around 3 to 4 centres in India have attempted POEM and a training course on the procedure has been planned in June at Global Hospital, Mumbai, for doctors from India and also surrounding Asian countries. An initiative – Foundation for Research and Education in Endoscopy (FREE) – too has been started to train doctors in this procedure as well as in many other advanced endoscopy procedures.

Source: The Times of India

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