Definition:
Is a disease characterized by the alteration of the movement of food from the esophagus to the stomach as a result of the muscle at the far end of the esophagus, which acts as a valve, failing to relax. The reasons for this failure to relax are yet unknown, and the food does not move on to the stomach. In some cases the malfunction is a result of infection by the parasite that causes Chagas disease.
Frequency:
Generally the disease presents between the ages of 30 to 50, and is equally frequently in men and women.
What are the symptoms?
The principal symptom is dysphagia, or the difficulty swallowing and passing food, initially with solids food but eventually with liquids. This symptom is magnified with foods that are either very hot or very cold. Other important symptoms are regurgitation or the return of food from the stomach back to the mouth, chest pain, progressive weight loss, and bad breath. These events can in time affect the social and working life of individuals.
What are the complications?
Significant dilation or enlargement of the esophagus referred to as “mega esophagus,” infections in the esophagus caused by fungus, hemorrhage of the esophagus, respiratory complications such as frequent infections and even pneumonia resulting from the aspiration of food into the lungs.
How is it diagnosed?
Performing and endoscopy is needed in order to observe the conditions of the esophagus, as well as a radiological study called GI and bowel series, and the confirmatory study of esophageal manometry that demonstrates the failure of the lower esophageal sphincter to relax.
GI and bowel series
Endoscopy
What is the treatment?
This condition can be treated via surgical or endoscopic means. The surgical treatment is called Heller myotomy, and consists in cutting the muscle of the lower esophageal sphincter to avoid the obstruction. This surgical procedure requires, additionally, performing a funduplication surrounds the esophagus with a stomach fold in order to restore the valve function.
The most modern and effective treatment is performed through endoscopy with minimal invasion, or the need to create incisions in the abdomen. This procedure, referred as POEM (Per Oral Endoscopic Myotomy), consists in opening a “window” in the mucosa of the esophagus in order to expose and cut the muscle of the lower esophageal sphincter from within the esophagus to eliminate the obstruction. The mucosa is then once again closed. The patient begins to ingest liquid food and is soon after discharged from the hospital
To watch an animated video of POEM visit: https://youtu.be/bdFfN8Vhw9c
The POEM can also be performed on patients with a previous surgical Heller myotomy that has proven to be ineffective and who persist with symptoms.
The creator of this novel and effective technique is Dr. H. Inoue, Japanese endoscopist, who has performed more than 1200 procedures to this day with excellent results.
In the Center for Endoscopy, we have experience in the diagnosis of achalasia and the performance of POEM with excellent results.
Dr. Carames received training in this procedure directly by Dr. Inoue, creator of the POEM technique.
Participando junto con el Dr. Michel Kahaleh en la enseñanza de éstas técnicas con endoscopistas de la república de Argentina