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POEM brings student relief from unusual swallowing disorder

December 07, 2015 | Patricia Harriman

Katie Hawkins with Dr. Kenneth Chang.

During her freshman year in college, Katie Hawkins began experiencing difficulty in swallowing food.

The Irvine resident, attending school in Idaho, attributed it to being in a different environment. Perhaps it was some kind of allergy, or maybe she should take smaller bites of food, or she was somehow swallowing the wrong way. Changing her diet and swallowing differently didn’t help. Her symptoms continued to worsen.

“I couldn’t eat,” she said. “I was throwing up everything I ate. The only way I could keep anything down was to drink lots of water, forcing the food down into my stomach. But then I would be choking at night when the food was trying to come back up. My roommates were afraid something bad was going to happen to me, and they begged me to see a doctor.”

The final straw for the three-sport athlete, who takes pride in her reputation as an “ace” volleyball server, was when she was so weak that she couldn’t even hit the ball over the net.

Naturally slim, the 5-foot, 7½ -inch tall Hawkins had lost 20 pounds. Her weight dropped to 105 pounds from 125, and she knew that she would be unable to continue to pursue her degree in recreational therapy or play volleyball, softball or soccer in that condition.

Achalasia diagnosis

Her doctor in Idaho diagnosed her with achalasia, a little-known swallowing condition that occurs when the lower sphincter muscle of the esophagus doesn’t open and let the food pass into the stomach. As a result, patients with achalasia experience a range of symptoms that include:

  • Difficulty swallowing
  • Heartburn
  • Chest pain
  • Food sticking
  • Regurgitation

Happy to know what was wrong after struggling for almost a year, Hawkins had two treatment options:

  • Heller myotomy, which would require a surgeon to cut into her to reach her esophagus
  • Peroral Endoscopic Myotomy (POEM)

“I wanted POEM because it’s less invasive, but my doctor couldn’t refer me. He said it’s a specialized procedure not offered in very many places, which meant that I had to take a break from school to get my condition treated. Luckily, I live in Orange County,” she said.

POEM procedure

The UCI Health H.H. Chao Comprehensive Digestive Disease Center is the only center in Orange County and one of only a handful on the West Coast offering POEM. Gastroenterologist Dr. Kenneth Chang, the center’s executive director, performed the procedure on Hawkins in May. Hawkins was able to finally return to school in June.

“At 20 years old, Katie is the youngest achalasia patient I have treated,” Chang said. “Achalasia is a rare condition, and it’s even more unusual to be found in someone her age. She was a great candidate for POEM, because she enjoys the benefits of surgery without the invasiveness, surgical wound healing and longer recovery.”

During the POEM procedure, Chang passed an endoscopic instrument through Hawkins’ mouth into her esophagus. From there, he made an incision in the internal lining of the esophagus which allowed the endoscope within the wall of the esophagus, exposing the muscle. He then cut the inner layer of the muscle near the lower esophageal sphincter into the stomach, and then closed the esophageal incision, all done internally.

Typically, POEM patients are admitted to the hospital overnight for observation and antibiotics, then receive a barium swallow X-ray the next morning to observe how well they swallow and then they can go home. Patients progress from clear liquids to full liquids to ensure there is no regurgitation. When they can tolerate liquids, the patient moves to a soft food diet.

Regaining weight and form

During her recent six-month check-up with Chang, Hawkins weighed in at her normal 125 pounds and happily reports that she has regained her ace form in volleyball.

“Most of all, I’m looking forward to the holidays,” she said. “Dr. Chang is awesome. Thanks to him, I really enjoyed eating Thanksgiving dinner with my family this year.”

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