Dr. Dennis Wigle: Achalasia overall is a very rare disorder that happens in less than one and 100,000 people in the population. And basically, it's a disorder of the innervation of the esophagus such that the esophagus doesn't squeeze properly and push contents down when people actually swallow and it's also a failure of the relaxation of the lower esophageal sphincter to allow contents to move from the esophagus into the stomach.
Dr. Shanda Blackmon: Patients with Achalasia frequently suffer from chronic regurgitation of food, dysphasia from problem swallowing, and weight loss. Patients who have Achalasia frequently are very difficult to discriminate between patients who might have cancer at the lower part of the esophagus versus patients who have other problems with esophageal motility.
Dr. Dennis Wigle: It's not really first in mind when someone presents with those symptoms. So sometimes it can take more work or more detailed testing in order to even recognize that maybe what someone's experiencing is not some of the other routine disorders we see in the esophagus and someone really gets a hint that this might be something like a Achalasia.
Dr. Shanda Blackmon: In our clinic, we have access to some of the latest equipment and utility to working out patients with Achalasia. We have endo flip, which is a balloon that goes inside the esophagus and measures the pressure within the esophagus to measure efficacy of treatment and measure and diagnose Achalasia correctly.
Dr. Dennis Wigle: We're constantly on the lookout for trying to figure out how do we provide the best palliation we can in the most minimally invasive way possible. And that's really where the rapid adoption of the POEM procedure comes in. To try and be able to do something similar to what already has a long history for Heller myotomy and do that, completely incisionless through an endoscopic approach.
Dr. Shanda Blackmon: A modified Heller myotomy is most frequently done with a laparoscopic approach. And that means small ports in the abdomen minimally invasive, cutting that muscle for about nine to 10 centimeters, extending the cut down on to the stomach. Unfortunately, after that muscle gets cut, patients have about a 25% chance of having pretty bad reflux that can result in esophagitis. And so the surgical approach is sometimes preferred for patients who really don't want to have reflux after the procedure. And the procedure can be followed by a laparoscopic fundoplication. And that's a partial wrap either on the front of the esophagus or the back of the esophagus. And that wrap is intended to prevent reflux.
Dr. Dennis Wigle: And then the other treatments that we use, like balloon dilation and Botox injection. They don't have as durable effect but the approach is the same to try and open up that lower esophageal sphincter and keep it open.
Dr. Shanda Blackmon: The multidsciplinary Achalasia clinic is comprised of a bunch of different providers here at Mayo Clinic. All of these teams work together to make sure that the patients get the best diagnosis, intervention and post operative care.
Dr. Dennis Wigle: Anywhere along the treatment paradigm right from diagnosis through to treatment and even follow up from there really at any point that would be appropriate to have a patient referred to us.
Dr. Shanda Blackmon: I hope that providers can trust Mayo Clinic to be there and help them get their patients the right diagnosis, the right treatment, the right intervention and deliver the patient back to them.
