Patient unable to swallow food finds relief in POEM
UC Irvine Health expert Dr. Kenneth Chang uses novel, scarless approach to treating the rare swallowing disorder achalasia.
January 16, 2015
For Bill Reeves, retirement has been nothing short of constantly being on the go. Reeves and his wife, Joanna, have spent the last few years as nomads living in their fifth wheel RV traveling the western United States. From California to Utah, Nevada, Washington, New Mexico and back to California, the Reeves have now made their home in the Sierras, just outside of Yosemite. During their travels to and fro, Reeves began experiencing difficulty swallowing which progressively worsened and led to him regurgitating most meals.
Reeves, who has a very active social life, curtailed his dining out with friends as he could not keep food down. He tried everything to keep from vomiting including sipping hot water between bites of food, thinking it would help. Sometimes it would but mostly, it didn’t make a difference.
Reeves also had trouble sleeping. For nearly a year, he slept sitting up in a chair because food would spew up anytime he lay down in bed. There was also concern that the regurgitation would lead to aspiration and pneumonia.
While seeking treatment in Nevada, Reeves’ Las Vegas-based physician advised him to return to California and see UC Irvine Health gastroenterologist Dr. Kenneth Chang. Reeves and his wife hit the road and headed to Orange County where Chang performed an endoscopy and made the diagnosis of achalasia.
“I went to several doctors who misdiagnosed me with either GERD or obesity,” said Reeves. “It wasn’t until I saw Dr. Chang that I received the correct diagnosis and a treatment plan. I’m incredibly grateful.”
The esophagus has two muscular rings – the upper and lower sphincters. The upper sphincter separates the esophagus from the throat, and the lower ring connects to the stomach.
The passage of contents from the esophagus to the stomach occurs through powerful and synchronized wave-like contractions that follow each swallow. This is called esophageal peristalsis. By the time peristalsis reaches the lower sphincter, it has opened and the food passes into the stomach.
Achalasia is a rare disease of the muscle of the lower esophageal sphincter. The ring of muscle located between the lower esophagus and the stomach isn’t able to open and let food pass into the stomach. As a result, folks with achalasia have symptoms that vary and include difficulty swallowing, chest pain, heartburn, regurgitation and food sticking.
After he heard all of the options, Reeves chose the novel Peroral Endoscopic Myotomy (POEM) procedure. UC Irvine Health H.H. Chao Comprehensive Digestive Disease Center is the only Orange County center offering the POEM procedure.
“Mr. Reeves was an excellent candidate for POEM,” says Chang. “The timing of the procedure was ideal as his achalasia wasn’t severe enough for him to be losing weight which is typical with achalasia. Now that we’ve performed the procedure, his esophagus won’t be baggy or dilated which happens when achalasia is left untreated for a long period of time.”
At 76, Reeves was a surgery rookie as he had never been operated on before. The POEM procedure was the least invasive surgical option, which was just fine with him.
During the POEM procedure, Chang used an endoscopic instrument that passes through Reeves’ mouth and into his esophagus. From there, Chang made an incision in the internal lining of the esophagus which allowed the endoscope within the wall of the esophagus, exposing the muscle.
Next, Chang cut into the inner layer of the muscle near the lower esophageal sphincter into the stomach. At the end of the operation, the esophageal incision was clipped closed. The procedure takes only two to three hours.
POEM patients are typically admitted to the hospital overnight for two to three days following the procedure for observation and antibiotics. The morning after the procedure, the patient will receive a barium swallow X-ray to observe the swallowing function. From there, patients are allowed to drink liquids to ensure there is no regurgitation. If liquids are tolerated, a patient will move on to a soft food diet the next day, and released from the hospital once foods are kept down.
For Reeves, POEM has made all the difference. He can keep food down and has only experienced a few bouts of acid reflux. Chang has him on Omeprazole, an acid blocker medication, which Reeves only has to take once a day.
“I’ve been able to resume my normal eating and no longer have to avoid making dinner plans with friends,” said Reeves. “My quality of life is so much better and my wife and I can now make plans to dine out and not fear that I’ll be sick.”
Prior to POEM, the typical treatment options included Botox injections to relax the sphincter muscles; oral medications; dilation, or widening, of the esophagus; or more invasive surgery.
“The long term prognosis for patients who undergo POEM is excellent,” says Chang. “While the esophagus isn’t ‘normal’ because it still lack peristalsis, the procedure provides lifelong durability and I expect patients to be symptom-free for the rest of their lives.”
Dr. Kenneth Chang is the director of the UC Irvine Health H.H. Chao Comprehensive Digestive Disease Center (CDDC). He is board certified in Internal Medicine and Gastroenterology. Chang was voted as Best Doctors in America® — Gastroenterology (2008-2014), a Physicians of Excellence by the Orange County Medical Association (2012-2014), and has received the Excellence in Teaching Award — Gastroenterology Division by UC Irvine Medical Center.
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