Patient finds relief after advanced treatment for achalasia

After struggling for more than a year to keep food down and losing 35 pounds, Craig Olczak finally found answers at Loyola Medicine.

“Swallowing and eating got a little harder,” said Olczak. “It was more of a sip, and then I would get spasms in my throat that would tighten up and then release. Then it got to the point where I couldn’t physically keep food down. I couldn’t drink water.” 

Olczak was diagnosed with achalasia, a swallowing disorder in which the nerves that supply the muscles of the esophagus, the tube that connects the mouth to the stomach, are damaged. Because of this nerve damage, the esophagus loses its ability to contract and move food downward. At the same time, the lower esophageal sphincter fails to relax, creating a functional obstruction that makes swallowing both solids and liquids extremely difficult.

“It can result in the regurgitation of food, chest pain, weight loss and significantly impacts quality of life," said interventional gastroenterologist Rohit Agrawal, MD.

Achalasia is often mistaken for reflux disease, and Olczak had been managed with acid‑reducing medication that did not improve his symptoms.

He came to Loyola in February of last year, where Dr. Agrawal discussed several treatment options. Olczak first opted to try an endoscopic therapy that included balloon dilation and Botox injection. When these provided only minimal improvement, physicians recommended a Peroral Endoscopic Myotomy (POEM).

POEM is a minimally invasive procedure in which doctors insert an endoscope, a thin, flexible tube, through the mouth to reach the lower esophagus and carefully dissect the muscles. Releasing this tension allows food to pass more easily into the stomach.

Olczak was admitted on the day of the procedure and monitored overnight. The following day, imaging confirmed there were no leaks in the esophagus. After the procedure was deemed successful, he was placed on a clear liquid diet and discharged.

Before treatment, Olczak’s diet was limited to the few foods he could swallow, mainly hot soup and carbonated beverages sipped slowly. Anything else would cause him to gag.

But within 24 hours of returning home, he was able to eat soft foods, and by about three days later, he was tolerating solid foods.

“Basically, I went into the hospital, and had it done, and by the next day, I went home,” said Olczak. “Everything kind of settled down, and I was eating food within 24 hours.”

Loyola is among the few Illinois centers offering POEM for advanced achalasia and esophageal spasms.

“Being able to offer this minimally invasive procedure, which is so effective and with minimal complications, is a game changer,” said Dr. Agrawal. “Patients feel a dramatic improvement in their swallowing. They put on weight, and seeing them even a week after in clinic and seeing the progression from not being able to eat, to tolerate everything is, is very satisfying.”