For Dennis Dunigan, the simple act of eating a meal had become torture. “I’ve lived the past 49 years with my swallowing disorder and its episodes of blockages, thinking that nothing else could be done to help me, that it was just something I would have to live with for the rest of my life,” says Dunigan, 61, of Chicopee.
After a five-day episode when Mr. Dunigan couldn’t keep down any solid food, and knowing his father had died the previous year from esophageal cancer, he saw his primary care doctor, who referred him to gastroenterologist Dr. David Kalman, of Springfield Medical Associates, in search of help.
Kalman performed an upper endoscopy and esophageal motility study, confirming Dunigan had a severe case of achalasia.
Esophageal achalasia is a rare disorder of the esophagus affecting its ability to move food toward and into the stomach. Patients gradually develop an inability to swallow solid foods, struggling to push them down into the stomach. In the most severe cases, they can’t even swallow their own saliva.
As their condition worsens, some patients suffer from extreme weight loss and malnutrition, painful spasms of their esophagus, and frequent regurgitation of undigested food, which can limit their ability to socialize by going out to eat or to parties. While there is no cure, there are treatments.
Dunigan would get up in the middle of the night to regurgitate food from supper. He avoided eating in restaurants or in public settings, afraid he wouldn’t be able to swallow the food he was eating, or that it would come back up.
“I thought he would be an excellent candidate for a new treatment being performed at Baystate Medical Center,” says Kalman. “This condition is not common. Baystate Medical Center is on par with the level of experience found at other major academic institutions in the country, and their multidisciplinary approach is very appropriate.”
The new, incision-less technique, first performed in Japan, is called per-oral endoscopic myotomy (POEM).
With achalasia, the muscular valve where the esophagus connects to the stomach doesn’t “relax” when food is swallowed, and the muscle in the esophagus itself fails to contract to push the food through. Thus the food does not pass into the stomach, and can build up in the esophagus.
During the POEM procedure, doctors insert a small scope through the mouth into the esophagus and make a small incision in the inner lining near the top of the esophagus. They then create a tunnel with the endoscope between the inner lining and muscular outer wall of the esophagus, and cut the stiff muscle fibers of the valve.
“I was only in the hospital one night after the procedure, and returned home around noon the next day,” remembers Dunigan. “I had some extreme heartburn after waking up in the recovery room, but after a glass of water it was gone within an hour.”
Today, Mr. Dunigan enjoys eating again and says he has his life back, noting he is “extremely pleased with the results.”
“Kudos to my doctors. Although my condition wasn’t life threatening, it was a quality of life issue for me. To be able to sit down and eat a meal and not have to worry about a blockage and bringing up my food, whether at home, in a restaurant, or in any other situation, well, that’s something that no one can understand unless they have my condition,” he says.