New Achalasia Treatment: POEM | News | Loyola Medicine

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Thursday, June 6, 2019

Loyola Medicine Offers Minimally Invasive Procedure To Treat Debilitating Swallowing Disorder

woman holding throat

MAYWOOD, IL – Loyola Medicine is among the first centers in Illinois to offer a new minimally invasive procedure to treat a debilitating swallowing disorder called achalasia.

The procedure is called peroral endoscopic myotomy (POEM). A gastroenterologist performs the procedure with an endoscope that is inserted through the patient's mouth. There are no incisions or scars, minimal pain and a fast recovery.

"POEM is an easily tolerated procedure that makes a dramatic lifestyle difference in patients," said Loyola gastroenterologist Nikhil Shastri, MD, who is among a handful of Chicago-area physicians who perform POEMs.  

Achalasia impairs swallowing in two ways. The esophagus (the tube connecting the throat to the stomach) does not effectively squeeze food down. Also, the muscular valve between the esophagus and the stomach, called the lower esophageal sphincter, doesn't relax sufficiently to allow food to enter the stomach. Eating food with achalasia is like trying to squeeze toothpaste out of the tube with the cap on, Dr. Shastri said.

Symptoms of achalasia include difficulty swallowing food and liquids, regurgitation of food, heart burn, chest pain, coughing and weight loss.

In the POEM procedure, Dr. Shastri inserts an endoscope in the patient's mouth and guides it to the lower esophagus. Using tiny tools that are passed through the endoscope, Dr. Shastri relieves the tightness in the esophageal sphincter, thus allowing food to pass to the stomach.

Following the procedure, the patient typically stays in the hospital for two days and returns to work the following week. Pain is minimal. Most patients require only a few doses of pain medicine, and some patients take no medication at all. Patients are restricted to a liquid diet for the first seven days, then transition to soft foods before eating solid foods.

The POEM procedure is an alternative to a laparoscopic procedure called a Heller myotomy, in which surgical instruments are inserted through multiple small incisions in the chest. While a laparoscopic Heller myotomy is less invasive than open surgery, it still is more painful and involves a longer recovery than a POEM procedure, Dr. Shastri said.

But not all gastroenterologists are able to offer POEM. "It's a technically challenging procedure that requires specialized training and advanced surgical backup," Dr. Shastri said. "POEM is an example of the advanced, subspecialty treatments available at academic medical centers such as Loyola."

Loyola Medicine is nationally ranked by U.S. News & World Report for its expertise in diagnosing and treating a broad range of gastrointestinal conditions and providing integrated services for optimal patient care.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.