Achalasia of the cardia is a condition resulting from a failure of coordinated peristalsis in the oesophagus. In other words food and drink aren't carried down the oesophagus in a wave after swallowing, resulting in difficulty swallowing and food sticking on the way down. The valve, or sphincter at the bottom of the oesophagus doesn't open as it should with swallowing and therefore causes a degree of blockage until it opens up.
Surgery to open up the sphincter muscle at the bottom of the oesophagus (Heller’s myotomy or cardiomyotomy) is currently the best treatment for achalasia. I regularly perform laparoscopic cardiomyotomy procedures, and have recently demonstrated the operation to a live audience of laparoscopic surgeons at their society's national conference (ALSGBI 2011).
Gastroparesis is a condition whereby the stomach fails to empty normally. Patients may experience vomiting, nausea, reflux symptoms, bloating, pain and poor nutrition. The condition may be associated with diabetes or can result from previous surgery on the stomach or oesophagus. The majority of cases do not however have an identifiable cause and are known as “idiopathic gastroparesis”.
Initially the condition is treated with medication, but some patients who do not respond may require surgery.
Traditionally surgery was used to improve drainage of the stomach. The success of this approach is variable, and increasingly patients are being treated by electrical stimulation of the stomach using a device similar to a pacemaker. The Enterra device (Medtronic TM) is a permanent implant with a pulse generator, which stimulates the stomach. This improves symptoms in the majority of patients.
I set up a gastric failure service in Leeds to treat patients with gastroparesis and we have implanted more than 70 Enterra devices since 2009.