Achalasia Cardia

What is Achalasia Cardia

Achalasia Cardia is a rare disorder of the esophagus characterized by the impaired ability of the lower esophageal sphincter (LES) to relax and allow the passage of food into the stomach. One of the treatment options for Achalasia is Per Oral Endoscopic Myotomy, commonly known as POEM.

Causes

Achalasia Cardia is caused by impaired relaxation of the lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES acts as a one-way valve, LES opens up, once the patient swallows food or drinking water. In between the meals, LES closes and prevents the upward movement of food or water

Symptoms

• Dysphagia: Difficulty in swallowing food or drinking water.
• Odynophagia: Pain while swallowing solids or liquids.
• Chest pain: Pain in the central part of the chest after meals.
• Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.

Diagnosis

• Upper GI endoscopy to rule out obstructing lesion
• Barium swallow
• High-Resolution Esophageal manometry

Treatment

• Poem is the new and highly effective treatment for achalasia cardia. POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at the GE junction is performed. For POEM procedure, the patient is admitted for 48 hours. After POEM procedure, X-ray is performed after 24 hours, and a liquid diet is started.
• Endoscopic pneumatic balloon dilatation
• Surgery-Lap Heller’s myotomy
• Botulinum injection
  
  

Per Oral Endoscopic Myotomy (POEM):

POEM is a minimally invasive endoscopic procedure designed to address the motility issues associated with Achalasia Cardia. Unlike traditional surgical interventions, POEM does not require external incisions. Instead, it is performed entirely through the mouth, using an endoscope to access and treat the affected area.

POEM Procedure:

• Anaesthesia: The procedure typically takes place under general anaesthesia to ensure the patient’s comfort.
• Endoscope Insertion: The endoscope is carefully introduced through the patient’s mouth and guided down into the esophagus.
• Myotomy: Using the endoscope, the doctor makes a small incision in the inner lining of the esophagus. Subsequently, they create a tunnel within the muscle layers, extending into the lower esophageal sphincter.
• Muscle Cutting: The muscular fibres responsible for dysfunctional motility are precisely cut, allowing for easier passage of food into the stomach.
• Closure: Once the myotomy is completed, the incision is closed with clips or other methods, ensuring the integrity of the esophageal wall.
  
  

Advantages of POEM Procedure:

• Minimally Invasive: As a purely endoscopic procedure, POEM eliminates the need for external incisions, reducing the risk of complications and expediting recovery.
• Customization: POEM allows for a tailored myotomy, enabling the doctor to address the specific needs of each patient.
• Quick Recovery: Patients often experience a faster recovery compared to traditional surgical interventions.
  
  

Post-Operative Care:

• Patients are usually kept in the hospital for 2-3 days for monitoring.
• A liquid or soft diet is recommended initially, gradually transitioning to regular foods.
• Follow-up appointments and tests may be scheduled to assess the effectiveness of the procedure.
  
  

Considerations: While POEM is generally considered safe and effective, all medical procedures carry some risks. Potential complications include bleeding, infection, and perforation of the esophagus. Patients should discuss the potential risks and benefits with their doctor.

Conclusion: Per Oral Endoscopic Myotomy has emerged as a promising treatment option for Achalasia Cardia, offering a less invasive alternative to traditional surgical interventions. Its success lies in its ability to provide relief from the symptoms of Achalasia while minimizing the impact on the patient’s overall well-being. As with any medical procedure, individual experiences may vary, and consultation with a doctor is crucial for personalized advice and guidance.