New cure for rare eating disorder

SINGAPORE - For years, mealtimes were a nightmare for a 63-year-old retiree, Mr Chandra.

A rare disorder, known as achalasia, meant food would get stuck in his oesophagus - the muscular tube channelling food from the mouth to the stomach- and cause him extreme discomfort.

It could take him as long as three hours to finish a bowl of porridge. "It was mentally very stressful," said Mr Chandra, who did not want to give his full name. "I felt totally miserable."

That was until October last year, when he went for a procedure that has been made available for the first time in Singapore.

In the last year, he and five other patients at the National University Hospital (NUH) have undergone peroral endoscopic myotomy, or Poem for short - a scarless procedure with good results and no complications.

Poem involves sending a flexible tube called an endoscope through the patient's mouth into his oesophagus to cut the muscle fibres that are preventing food from entering the stomach.

Achalasia, which affects about one in 100,000 people worldwide, occurs because a muscular ring in the food pipe - the lower oesophagal sphincter - fails to relax to allow food to enter the stomach.

Over time, the oesophagus becomes dilated. This worsens the problem, according to Associate Professor Jimmy So, head and senior consultant at the division of general surgery (upper gastrointestinal surgery) at NUH.

Before Poem was developed, doctors would divide the muscle by making five or six small cuts in the abdomen, in what is known as laparoscopic myotomy.

Another procedure, known as balloon dilation, involved inserting and dilating a balloon through the mouth to tear the sphincter muscle.

However, this procedure puts patients at a 4 per cent risk of suffering a perforated oesophagus, which can cause surrounding organs to get infected. This risk stands at 1 per cent for laparoscopic myotomy and is further slashed to 0.5 per cent with Poem.

It is hoped that Poem, which was first used in Japan in 2008, will be a permanent cure for all grades of achalasia, although long-term and comparative studies are not available yet.

Overseas studies have reported a success rate of more than 90 per cent after a year. Prof So said

Poem has been performed in China, Hong Kong, South Korea, North America, the Netherlands, Germany and Italy.

Poem is cheaper, costing between $4,000 and $5,000 for a subsidised patient including hospital stay, compared to $5,000 to $6,000 for laparoscopic myotomy.

Prof So said it also involves a shorter hospital stay of two or three days, compared to up to five days for laparoscopic myotomy.

This article was first published on January 22, 2015.
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