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The per-oral endoscopic myotomy, or POEM, is a minimally invasive surgical procedure for the treatment of achalasia wherein the inner circular muscle layer of the lower esophageal sphincter is divided through a submucosal tunnel. [1] This enables food and liquids to pass into the stomach, a process that is impaired in achalasia.
Without a modifier, "achalasia" usually refers to achalasia of the esophagus. Achalasia can happen at various points along the gastrointestinal tract; achalasia of the rectum, for instance, may occur in Hirschsprung's disease. The lower esophageal sphincter is a muscle between the esophagus and stomach that opens when food comes in.
Heller myotomy is a surgical procedure [1] in which the muscles of the cardia (lower esophageal sphincter or LES) are cut, allowing food and liquids to pass to the stomach.It is used to treat achalasia, a disorder in which the lower esophageal sphincter fails to relax properly, making it difficult for food and liquids to reach the stomach.
If symptoms are severe or persistent, peroral endoscopic myotomy (POEM) may be offered. [2] Pneumatic dilation may be used for persistent symptoms in the absence of identified causes of mechanical obstruction. [2] Botulinum toxin may be considered, [5] especially for individuals who are unlikely to tolerate surgery. [2]
Dysphagia to liquids, in particular, is a characteristic of achalasia. Other symptoms of achalasia include regurgitation, night coughing, chest pain, weight loss, and heartburn. The combination of achalasia, adrenal insufficiency, and alacrima (lack of tear production) in children is known as the triple-A (Allgrove) syndrome.
In contrast, surgery for achalasia is generally accompanied by either a Dor or Toupet partial fundoplication, which is less likely than a Nissen wrap to aggravate the dysphagia that characterizes achalasia. In a Dor (anterior) fundoplication, the fundus is laid over the top of the esophagus; while in a Toupet (posterior) fundoplication, the ...
Sharon Osbourne opened up about the emotional toll her gastric bypass surgery took on her life, and the unexpected shame she felt after the procedure. Check out photos of the family over the years:
Advanced achalasia is characterized by regurgitation of previously swallowed, undigested food material. Individuals with diffuse esophageal spasm or nutcracker esophagus , due to disordered peristalsis propagation, may experience severe chest pain and dysphagia, mimicking cardiac ischemia .