Achalasia Cardia is a debilitating disease that affects the food pipe, also called the esophagus. A recent advancement called POEM or Per Oral Endoscopic Myotomy (POEM) has dramatically improved the treatment outcomes of this complex disorder.
The Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences (ILGPS) at Sir Ganga Ram Hospital has consistently been at the forefront of performing and pioneering POEM procedures in North India, the chairperson of ILGPS recently announced the successful completion of 375 POEM procedures in their department over the last five years.
These patients were in the age range of 14-90 years with a mean age of 47 years with 43 per cent females and 57 per cent males.
The esophagus performs the vital function of transporting the food that we eat into the stomach for digestion. A valve-like muscle called as Lower Esophageal Sphincter (LES) is present between the oesophagus and the stomach which permits a one-way transit of oesophagal contents into the stomach.
According to Dr. (Prof.) Anil Arora, Chairman, Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, "In Achalasia Cardia, the LES fails to relax during swallowing and hence food cannot enter the stomach and gets stuck up in the food pipe.
As a result, the patient with Achalasia Cardia have difficulty in swallowing, develop chest pain followed by vomiting out of the swallowed food. The symptoms can be devastating with most patients suffering from loss of weight and poor quality of life."
According to Dr (Prof.) Anil Arora, "The biggest enigma in the diagnosis of this rare condition which occurs in one in 100000 individuals is that the disease is often missed initially and is mistakenly diagnosed as Gastroesophageal reflux disease called GERD which is a very common condition prevalent in one-fifth of the population as the symptoms of chest pain, vomiting and regurgitation of food are equally prevalent in both diseases with diagrammatically opposite treatment.
"This is where a good and meticulous history of the patient coupled with barium studies, endoscopy and high-resolution manometry studies of esophagus come in handy in making a proper diagnosis and selecting the appropriate treatment modality," said Prof. Arora.
According to Dr Shrihari Anikhindi, Consultant, Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, "Among the various treatment options available for Achalasia Cardia, POEM has now become the preferred treatment option due to its minimally invasive non-surgical nature and rapid and almost complete symptom relief with excellent outcomes. In POEM, the non-relaxing LES is cut from within the cavity of the oesophagus using endoscopy (Figure2). Reporting on their experience, they have noted excellent success rates of up to 95 per cent at their centre."
"The entire procedure takes around 1-1.5 hours and is performed under general anesthesia and hence is painless and quite comfortable for the patient. Most patients are able to resume diet from the very next day and are discharged within 48 hours," said Prof. Arora.
Prof. Anil Arora, further added, "thanks to recent strides in medical technology, the diagnosis and treatment of swallowing disorders has undergone a sea change. What we can achieve today in this field, was nearly impossible even 10 years back. With state-of-the-art advanced diagnostic procedures like high-resolution esophageal manometry and high definition endoscopes, we can pinpoint the diagnosis in all patients with swallowing disorders like Achalasia Cardia.
"Having an established and well accomplished advanced endoscopy unit coupled with high definition pressure and movement monitoring manometric equipment for esophagus stomach intestine and rectum helps us in providing the appropriate diagnosis and well-planned state of the art solutions to their complex problems," said Prof. Arora.
Prof. Arora also added that it will be important to note that even though the rare problems of food pipe motility disorders like achalasia cardia began early in life because of their shared common symptomatology of chest pain vomiting and difficulty in swallowing with more common problems like GERD the diagnosis is frequently missed and delayed resulting in onerous complications.
Hence a timely consultation and appropriately guided tests can provide proper treatment and save many from misery, he added. (ANI)