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Easy to Swallow

Written by Hailey Middlebroook

Thoracic surgeon Dr. Adam Mace is on a mission to help relieve symptoms of achalasia, a painful swallowing disorder, through a new, minimally invasive procedure 

If you’ve ever suffered from heartburn, you know how painful the burning sensation in your chest can be. Luckily, the symptoms of this common condition—which also include chest tightness after eating, acid reflux and food regurgitation—are only temporary for most people. For those with a rare condition known as achalasia (ei·kuh·lei·zhuh), however, these painful symptoms can occur after every meal, snack or drink.

Dr. Adam Mace
Dr. Adam Mace

According to Roper St. Francis Healthcare affiliated thoracic surgeon Dr. Adam Mace, 10 in every 100,000 people in the U.S. suffers from achalasia—a medical condition that impairs swallowing. “Normally, food passes easily from the throat to the stomach via a valve that opens and closes in the esophagus,” explains Dr. Mace. “But for patients with achalasia, this valve doesn’t function properly and remains partially or fully shut.”

Although achalasia is a progressive disorder that cannot be cured, thankfully, the symptoms can be alleviated with surgery. Dr. Mace is currently piloting a minimally-invasive procedure called peroral endoscopic myotomy (POEM), which uses an endoscope to reach down the esophagus and open the valve to the stomach without making any external cuts. “It has the same success rate as traditional surgical methods but yields a much faster recovery,” says Dr. Mace of the new procedure.

HC: What are the symptoms of achalasia and who does the condition affect?
AM: People with achalasia typically have extreme difficulty eating. At first, they may feel a sensation of food sticking in their chest or painful spasms when swallowing food. Over time, they regurgitate frequently, and in severe cases, aspirate food into their lungs. Late-stage achalasia patients are often forced to live on a liquid diet as they can’t get solid food down at all. Because it’s rare and the symptoms overlap with other more common disorders, patients are often not diagnosed until the disorder has progressed to this point. Achalasia affects men and women of all ages, but it is diagnosed most commonly in young adults and those over 60. We still don’t know exactly what causes it.

HC: How is achalasia treated?
AM: There are non-surgical treatments, such as Botox injections, which relax the throat muscles, and dilation treatment for the valve. These can be very effective, but typically offer only temporary relief. Traditionally, achalasia has been treated surgically with an operation called a Heller myotomy. During this procedure, an incision is made in the chest or abdomen and the overactive muscle fibers closing off the valve in the lower esophagus are divided surgically. There’s also the new procedure, POEM, which is less invasive and does not require external incisions. With both treatments, more than 80 percent of patients will get long-term relief from their symptoms.

HC: Can you tell us more about POEM?
AM: Instead of going through incisions in the abdomen or chest, the surgeon reaches the lower esophagus using a flexible endoscope introduced into the mouth and down the throat. The procedure is done under anesthesia with the patient fully asleep. The surgeon makes a small cut in the inner lining of the esophagus and, using the endoscope, divides the overactive muscle fibers at the junction of the stomach. Doing so allows food and liquids to pass more easily into the stomach and alleviates the symptoms of achalasia.

HC: What is the recovery process like for POEM?
AM: The whole procedure takes a few hours. Patients are typically only in the hospital overnight following the surgery, return to normal activity right away and are pain free in two to three days.

All patients having surgery for achalasia aren’t allowed to eat or drink for the first day after treatment; for two weeks following that, they are prescribed a liquid diet. Afterward, solid food is reintroduced and nearly all patients have a significantly easier time eating a normal diet. Since the valve linking the esophagus to the stomach is permanently opened as a result of the procedure, the main potential complication is an increase in acid reflex, but only about 10 percent of patients report experiencing severe reflux after undergoing POEM, and most of the time it can be effectively managed with antacids. Overall, the surgery is very safe and can truly be life-changing.

Photographs by (Dr. Mace) Mic Smith Photography & (woman drinking) Rido/Shutterstock

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