Dr. John Sharp, a gastroenterologist, performed a medical "first" at Yampa Valley Medical Center this summer. His patient, a 57-year-old man who lives in Craig, had suffered for years from a condition that affected his ability to swallow foods and liquids.
Although the patient was diagnosed with dysphagia, Sharp was reasonably certain that he actually had a more serious problem called achalasia.
"This inflammatory condition causes the esophagus to close," Sharp explained. "The tightly intertwined muscles of the esophageal sphincter can't relax to allow swallowing in the portion that runs between the chest and stomach. It is genetic, and the patient's sister had been treated for achalasia previously."
Both conditions can interfere with or even prevent swallowing and cause pain, malnutrition or lung infection.
Sharp said dysphagia or achalasia can be treated by Botox injections that paralyze and relax the sphincter muscles of the esophagus, providing temporary relief. This method usually requires follow-up injections, but it may be recommended for older individuals who are considered at risk for a more complicated procedure.
"Patients can also receive surgery called a Heller myotomy in which the esophageal muscles are cut surgically," Sharp said.
Sharp had previously seen two other patients suffering from achalasia and referred them to other hospitals for treatment. This time, Sharp decided to combine diagnosis and treatment in one procedure called balloon dilation and perform it at Yampa Valley Medical Center.
"Balloon dilation is designed to stretch the esophageal muscles sufficiently to separate them," Sharp said. "Ideally the esophagus still stays intact, with possible minor tears, but the sphincter will be stretched out sufficiently to allow food and liquid to be consumed."
On June 16, Sharp inserted the balloon into the patient's esophagus and then inflated it to three centimeters, or about the size of a half-dollar. The precise placement and expansion of the balloon was monitored by a previously inserted endoscope. After 30 seconds of continuous pressure, the balloon was deflated and removed.
"The muscles of the esophagus slid apart sufficiently," Sharp reported. "On his follow-up visit, the patient was swallowing normally. He had received very good relief from the procedure, which took only four hours from check-in to discharge."
Depending on the age and condition of a patient, balloon dilation may be the recommended treatment for achalasia.It is available to residents of the Yampa Valley.