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POEM procedure solves puzzling swallowing condition

June 30, 2016 | Patricia Harriman

Jared Eves

Although he had been experiencing difficulty in swallowing food during the past 10 years, 24-year-old Jared Eves was not convinced that the endoscopic treatment recommended by gastroenterologist Dr. Kenneth Chang was right, until he saw the barium swallow X-ray.

“I could see what my esophagus looked like,” the St. George, Utah resident said. “I could see it looked normal, until the last sphincter, where the food stayed. Instead of going into my stomach, the food stayed at the bottom of my esophagus, stretching it out.”

Eves’ reluctance was the result of a decade-long battle with increasing difficulty in swallowing, an initial misdiagnosis, and dealing with type 1 diabetes at the same time.

Difficult to manage two conditions simultaneously

By the time he was 15, Jared’s parents knew that his difficulty in swallowing was something that needed to be checked out. The pediatric gastroenterologist in his home town diagnosed his condition as eosinophilic esophagitis, an allergic condition that causes an inflammation or swelling of the esophagus, making swallowing difficult.

“The combination of food allergies and diabetes presented some unique challenges in trying to manage both conditions,” Eves says. “Trying to identify what was causing allergic reactions while being careful to maintain my blood sugar level made food selection difficult at times.” 

The correct diagnosis and decision

His health issues did not prevent him from leaving home to serve a two-year mission in Spokane, Washington for the Church of Jesus Christ of Latter-day Saints. While away from home, his condition steadily worsened. There were times when he could not even swallow water. Upon his return home in January of last year, he underwent a manometry, which measures the function of the lower esophageal sphincter. The initial diagnosis was achalasia and the barium swallow test results confirmed it.

The Eves family first met Chang in November 2015. Another family member, Katie Hawkins, had a follow-up appointment with Chang. He had treated her for achalasia earlier that year, through a procedure called Peroral Endoscopic Myotomy (POEM).

Hawkins was so pleased with her recovery that she wanted her cousin to talk to the doctor about having the POEM treatment as well.

It was during his appointment with Chang that Eves saw the X-ray of his esophagus and made his decision. He would undergo the POEM procedure when he was out of school in June.

Chang is executive director of the H.H. Chao Comprehensive Digestive Disease Center, the only center in Orange County and one of only a handful on the West Coast offering POEM.

The POEM procedure

The POEM procedure is all done internally. Chang passed an endoscopic instrument through Eves’ mouth into his esophagus, making an incision in the internal lining, exposing the muscle. Chang then cut the inner layer of the muscle near the lower esophageal sphincter into the stomach, then closed the incision.

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

Reluctance replaced by optimism

“Katie’s experience has been a comfort to me, because I have seen how well she’s done,” Eves says. “I know Dr. Chang is a great doctor, and getting to have my procedure done by him in the same place Katie did is very reassuring.” 

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