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ACHALASIA OF CARDIA

UNDERSTANDING THE PROBLEM

The oesophagus is the tube that conveys food from the throat down to the stomach. Achalasia is a condition in which the muscles of the lower part of the oesophagus fail to relax preventing food from passing into the stomach. As a result, a backup of food can remain in the oesophagus.

UNDERSTANDING WHO SUFFERS

Achalasia is a rare primary motility disorder of the oesophagus that affects one person in 100,000 per year. It may occur at any age, but is most common in middle-aged or older adults. In some people, the problem may be inherited. Achalasia in children is rare also, but the incidence is rising

Researchers have long suspected that an autoimmune response lies at the root of the disease, but an explanation for why the immune system of people with achalasia responds as it does remains elusive.

POTENTIAL SIGNS AND SYMPTOMS

The symptoms of achalasia are usually mild at first, but typically get progressively worse:

  • Dysphagia - difficulty in swallowing or a feeling that food is in the oesophagus
  • Regurgitation of indigested food. Regurgitation may occur in 80-90% and some patients learn to induce it to relieve pain. As symptoms worsen regurgitation involves liquids as well as foods
  • Weight loss
  • Coughing, especially when lying down
  • Chest pain, often perceived as heartburn. Chest pain occurs in 25-50%. It occurs after eating and is described as retrosternal. It is more prevalent in early disease. In some cases the patient may think he/she is having a heart attack
  • Aspiration - food, liquid and saliva which is retained in the oesophagus can be inhaled into the lungs
EXAMINATIONS USUALLY REQUIRED

Examinations that are usually required include:

  • Barium swallow usually precedes endoscopy when investigating dysphagia, as it is very easy to perforate a malignancy if present with an endoscope. The barium swallow in achalasia is characteristic. The oesophagus is dilated and contrast material passes slowly into the stomach as the sphincter opens intermittently. The technique can be enhanced by having patients drink tap water during visualisation of the lower oesophagus in an attempt to clear the standing barium column.
  • Endoscopy: Having ruled out obvious malignancy with a barium swallow, many specialists proceed to endoscopy, which can detect approximately a third of achalasia cases, although some still prefer to perform manometry at this stage
  • Manometry of the oesophagus: is the gold standard for diagnosis of achalasia and can detect up to 90% of cases. If manometry is normal but clinical symptoms or radiological evidence suggest achalasia, a condition called pseudo achalasia may be present.
  • Lower oesophageal pH monitoring: This may also be required to exclude gastro-oesophageal reflux disease (GERD) which often occurs with achalasia. If present it should mitigate against treatment by pneumatic dilatation (which causes about a 30% incidence of GERD).
PROPOSING TREATMENT AND WHY AIMIS

The goal of treatment is to reduce the pressure at the sphincter muscle and allow food and liquids to pass easily into the stomach. Therapy may involve:

  • Injection with botulinum toxin (Botox). This may help relax the sphincter muscles. However, the benefit wears off within a few weeks or months.
  • Medicines, such as long-acting nitrates or calcium channel blockers. These drugs can be used to relax the lower esophagus sphincter.
  • Surgery called a myotomy. In this procedure, the lower sphincter muscle is cut.
  • Widening (dilation) of the esophagus at the location of the narrowing.

A Myotomy also known as Heller Myotomy is most frequently performed using minimally invasive techniques (laparoscopic or robotic ) using small incisions although it can also be performed through an open incision in the abdomen or the left side of the chest between the ribs. The surgeon will cut the affected muscles in the esophagus and stomach to make it easier for food to reach the stomach.

AIMIS is an expert in Da Vinci Minimal invasive robotic Myotomy and Single Site ® Heller Myotomy and provides advanced techniques offering many advantages over standard laparoscopy such as:

  • Greater precision using wristed surgical instruments.
  • Virtually scar less surgery in Single site surgery with single incision through the belly button
  • Better margins with potential less disruption to surrounding tissue
  • Patient that are treated with a robotic myotomy will typically leave the hospital in one to two days and able to return to their normal activities within a week.

To see the procedures we undertake with Robotic Xi Surgery, please click here

REPUTABLE AND PRESTIGIOUS SURGEONS

Dr. Konstantinos Konstantinidis is the Adjunct Professor of General Surgery at the Ohio State University, USA, the President & Founder of South Eastern European Robotic Surgical Society SEERSS, Chairman of Genera Surgeryl, Bariatric, Laparoscopic & Robotic Surgery at Athens Medical Center amongst many other appointments. He practiced as Director of the Surgical Clinic of Riverside Methodist Hospital, where he operated and taught General Surgery, Laser Surgery, and Laparoscopic Surgery for many years. To date, he has performed more than 10,000 laparoscopic surgical operations and has provided surgeons of other specialties (General Surgeons, Gynaecologists, Urologists, Thoracic Surgeons) the opportunity to learn the entire range of Minimally Invasive, Laparoscopic, and Robotic Surgery.

Dr. Konstantinidis is an expert in all types of Gastroenterology procedures and is highly regarded for his treatment of gastroenterology cases and treatment with laparoscopic and da Vinci robotic and single site robotic techniques.

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

The main complication of achalasia is weight loss. Other potential complications are:

  • Untreated achalasia may lead to inhalation of material lodged in the esophagus and result in aspiration pneumonia.
  • Inflammation in the lining of the esophagus due to food and fluid which collect and cause irritation.
  • Treatment may cause perforation of the oesophagus.
  • Treatment may lead to GERD.
  • Oesophageal cancer
  • Long-standing disease increases the risk.
  • Presumably potential carcinogens are held in the oesophagus instead of being moved along.
FURTHER INFORMATION ON INCREASED RISK GROUPS

Recent studies have indicated that achalasia may be caused by an immune disorder in which the patient’s own immune system attacks the nervous system within the muscles of the esophagus, causing them to malfunction.

Achalasia doesn’t affect any particular race or ethnic group, and the condition does not run in families. Esophageal motility disorders develop slowly and worsen over time. Experiencing only a brief episode of symptoms probably means it’s not a true esophageal motility disorder.

Patients with achalasia are sometimes initially treated for gastroesophageal reflux disease (GERD) before being diagnosed with achalasia on further testing.

FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

A doctor might suspect achalasia if there is trouble swallowing both solids and liquids, particularly if it gets worse over time.

Further exams that might be required are:

  • Manometry of the oesophagus (Manometry is the gold standard for diagnosis of achalasia. and can detect up to 90% of cases.)
  • CXR (This may possibly show signs of inhalation)
  • Barium swallow x-ray (The barium swallow in achalasia is characteristic)
  • Endoscopy (can detect approximately a third of achalasia cases)
  • Lower oesophageal pH monitoring (This may also be required to exclude gastro-oesophageal reflux disease (GERD) which often occurs with achalasia.)
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Upper Gastrointestinal Problems including:
Fundoplication Surgery, Minimally Invasive Heller Myotomy Surgery, Subtotal Gastrectomy Esophageal Stent Placement, Esophageal Surgical Repair, Esophagectomy, Esophagus Replacement and other minimal invasive procedures involving the best American and International surgeons who are experts in the field

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for Upper Gastrointestinal problem and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Greater precision
  • Minimal Scarring
  • Better margins with potential less disruption to surrounding tissue
  • High patient satisfaction
  • Minimal pain
OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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