​Eating again after achalasia

Achalasia patient, Dorian Brantley, enjoying pizza for the first time after surgery

Tacos.

Pizza.

A steak, medium well, with a loaded baked potato.

“And a crisp apple,” Dorian Brantley added. “I was eating applesauce, but there’s no comparison.”

These were the top items on Brantley’s list of what-to-have-first after surgery for achalasia — a rare digestive disease that makes it hard to eat or drink.

Following a successful endoscopic procedure, Brantley, 35, has happily completed her to-eat list.

About a year ago, Brantley, a nurse at UChicago Medicine, noticed that it seemed to be taking a long time for food to move down her esophagus. At first, she thought maybe her portions were too large or she was eating too quickly.

Dorian Brantley, achalasia patient, talking with her surgeon, Irving Waxman, MD
Dr. Irving Waxman with Dorian.

But the condition became more and more uncomfortable. And soon both eating solids and drinking liquids caused pain.

“If my patients told me this, I’d be very concerned,” she thought.

Brantley tried a soft diet, but it didn’t help. A barium swallow test at UChicago Medicine showed that her esophagus wasn’t functioning properly.

Gastroenterologist and interventional endoscopist Irving Waxman, MD, suspected achalasia. He performed an upper endoscopy to rule out stomach or esophageal cancer. Robert Kavitt, MD, MPH, then did an esophageal manometry study — a test that measures muscle contractions — and confirmed the achalasia diagnosis. Instead of relaxing to let food pass through, the smooth muscular valve at the lower end of Brantley’s esophagus (lower esophageal sphincter) was staying closed all the time.

The endoscopic approach, offers patients a quick recovery, no scar and a short hospital stay.

The cause of achalasia is not known. “But we do know it is a progressive and irreversible disease,” Waxman said. “It can lead to serious problems in the lungs and malnutrition.” Brantley had lost 30 pounds between June and October.

Even as a nurse, Brantley had never heard of achalasia. “Dr. Waxman answered all my questions and put me at ease,” she said.

In late October 2017, Waxman performed a procedure called peroral endoscopic myotomy (POEM). Placing a flexible scope into Brantley’s esophagus through her mouth, he created a tunnel between the layers of her esophagus to reach the lower sphincter, where he cut the muscles, permanently opening the valve.

Dorian Brantley working as a nurse at UChicago Medicine

 

“The endoscopic approach, offers patients a quick recovery, no scar and a short hospital stay,” said Waxman, director of the Center for Endoscopic Research and Therapeutics (CERT).

After the procedure, Brantley was anxious at first about going back to solid foods.

“But Dr. Waxman, his nurse, my coworkers, friends and family all encouraged me to ‘go ahead and eat again,’” Brantley said. “You know what, I did. Everything was delicious.”

Center for Endoscopic Research and Therapeutics (CERT)

The mission of the CERT program is "to advance patient care through endoscopic discovery and innovation." Our highly trained, expert physicians and nurses live our mission every day, performing more than 2,000 specialized ultrasound and interventional endoscopy procedures annually and ranking among the nation's leaders in progressive techniques.

Read more about the CERT program
Irving Waxman, MD

Irving Waxman, MD

Dr. Irving Waxman is the director of the Center for Endoscopic Research and Therapeutics (CERT). The center focuses on new imaging modalities for the detection of early gastrointestinal cancer; minimally invasive endoscopic resection of superficial gastrointestinal malignancies; and combined endo-surgical minimally invasive interventions.

Read Dr. Waxman's bio