Achalasia is a rare disease which causes damage to the nerves in the esophagus. Patients have difficulty swallowing, heartburn, and chest pain. Many also experience weight loss. While there is yet to be a cure for the condition, there are treatments available to help patients manage the symptoms.
The ultimate goal of this symptomatic treatment is to relax the lower esophageal sphincter muscle (LES) to help food pass through more easily. This treatment can be medicinal or through mechanical means.
The most common therapy is a pneumatic dilation. In this procedure, a balloon is filled with air and endoscopically guided to be placed over the LES. However, this procedure is less permanent than a laparoscopic Heller myotome. This option is an invasive surgery where cuts are placed in the LES to weaken it. Unfortunately, like any invasive procedure, this option carries more risks and potential for complications.
Clearly, a better option is still needed for achalasia patients and thankfully, a new study may have found a solution.
POEM stands for perusal endoscopic myotomy. Technically, this procedure was first introduced in 2009. But it had never before been adequately tested through clinical trials. Essentially, POEM allows the myotomy to be completed endoscopically. It’s the best of both worlds! By completing the procedure through the mouth, patients recover more quickly, have less risk of complications, and have a more permanent solution. Additionally, there are no open wounds to be healed or scars to worry about.
Researchers at the University of Amsterdam in the Netherlands finally conducted the first clinical trial investigating POEM as the initial treatment for the disease. This study was co-authored by Peter Kahrilas and John Pandolfino and published in the journal JAMA. The trial included 133 patients who were diagnosed with achalasia and had never received treatment for their disease. All of the participants were randomized to either receive the standard care (pneumatic dilation) or POEM.
The primary outcome of the investigation was reduction in Eckardt score to 3 or less. This score measures the symptoms of the disease. Also measured were the presence of severe complications and whether or not the patient needed to be treated again.
Patients were evaluated at the 2 year mark. The POEM group had a success rate of 92% whereas the pneumatic dilation group had a success rate of only 54%. Additionally, no patient in the POEM group experienced an AE however 2 in the pneumatic dilation group did.
In fact the only negative in the POEM group seemed to be a more frequent development of reflux esophagitis. As a result, proton pump inhibitors (to relieve the symptoms of the acid reflux) were also used more in this group.
However, overall, it is clear that the POEM group experienced superior outcomes.
Researchers believe that these results will help POEM be accepted as the go-to therapy in achalasia treatment.
However, despite its successes, the researchers are not yet satisfied with POEM. They are working to tailor the technique so that it can work better for individual patients. Without a doubt, we are making progress in the research for this rare disease and that in and of itself is exciting.
You can read more about this method of treatment here.