As a specialist in achalasia, Mr Clarke follows current national and international guidelines (see resources), using up-to-date investigation techniques, as well as keyhole (laparoscopic) surgery.
Achalasia is a disorder of the gullet (oesophagus) in which the muscles fail to move food along properly and the valve at the lower end of the oesophagus fails to open, preventing food passing into the stomach normally. It is an uncommon condition that is diagnosed in 1 in 100,000 people annually, affects males and females equally and is commonest between 30 -60 years of age.
Damage to or loss of the nerves in the wall of the gullet (oesophagus). The underlying cause for this remains largely unknown, however there may be some association with certain viral or autoimmune conditions (in which the immune system attacks healthy cells and tissues). In patients with achalasia there is thought be an increased likelihood of developing oesophageal cancer in the future.
The commonest symptoms include difficulty swallowing (dysphagia), pain on swallowing and/or regurgitation of undigested food after meals. In some patients this can cause choking, coughing , heartburn or weight loss.
In some patients there may be no symptoms and it is incidentally detected during investigations for other diseases.
Three investigations are normally required:-
A thin telescope is passed via the mouth using local anaesthetic and/or sedation to inspect the gullet (oesophagus), stomach and duodenum.
A white dye containing barium is swallowed and its movement along the gullet towards the stomach is videoed using x-ray.
This is the gold standard investigation for achalasia. A thin tube is passed via the nose and a series of pressure measurements are made whilst the patient swallows small sips of water to assess the function of the gullet (oesophagus).
Current recommendations are that graded pneumatic dilatation or surgical myotomy are recommended as initial treatment for those fit and willing to undergo these procedures. Injection of botulinum toxin is recommended for those patients not suitable for dilatation or surgery. Medication is recommended for those not suitable for dilatation or surgery and in whom botulinum toxin injection has failed.
Each of these treatments is outlined below:-
Under sedation or a full general anaesthetic, a balloon (3-4cm in diameter) is passed into the gullet (oesophagus) via the mouth. Under x-ray guidance it is inflated to stretch and disrupt the muscles of the valve at the lower end of the gullet. This may need to be repeated after one or more years. There is a risk of rupture of the gullet that may require surgery (around 1 in 50 patients).
Once a decision is made to go ahead with surgery, you will need to attend the pre-assessment clinic, at which a number of routine checks and blood tests will be performed.
Surgery is performed with keyhole (laparoscopic) surgery. Five keyhole incisions are made in the upper part of the tummy (abdomen). The operation involves dividing the muscles (myotomy) of the valve at the lower end of the gullet that fails to relax. The top section of the stomach (fundus) is then stitched across this divided valve to prevent acid or food regurgitating back from the stomach into the gullet. This is known as a ‘fundoplication’ or ‘wrap’. The procedure normally takes 1-2 hours.
Patients are normally ready to be discharged the following day after surgery. You will be discharged with painkillers and written post-operative instructions. All stitches are dissolvable. The waterproof dressings are suitable for the shower and can be removed after 7 days.
You are advised to drink fluids only for the initial 24 hours after surgery before commencing a mashed diet for the following 3 weeks. More solid foods can then be gradually reintroduced as tolerated.
Recovery can take around two weeks however you are advised to avoid heavy lifting for up to 6 weeks after surgery.
The muscle at the lower end of the gullet (oesophagus) can be relaxed using medications such as nitrates or calcium channel blocker drugs (e.g. nifedipine). These may provide temporary relief and are not effective in all aptients.
Botulinum toxin is injected painlessly into the muscle of the valve at the lower end of the gullet (oesophagus) via endoscopy. This can be effective for a few months to years.
I would without hesitation recommend Mr Clarke. Feel very fortunate to have been assigned to him for operation.
Mr Clarke was extremely efficient both in consultation and surgery. He was very caring and took time to explain procedures.I would highly recommend him.
Very pleased with outcome of op from Mr Clarke. Just like 2016 he was very helpful and so professional. Would definitely recommend.
I felt at ease from the moment I had my first appointment all the way through to my operation.
Excellent manner both in consultation, pre- and post-op. Would definitely be happy to see him and recommend to others requiring surgery.
Mr Clarke made the whole experience a breeze. So calm, polite and understanding of patients' needs.
My introduction to Mr Clarke was met with a warm smile and a firm handshake. He was professional and friendly and put me at ease. I have no hesitation in recommending Mr Clarke.
Mr Clarke did everything he said he would. Appointments came through quickly and I was made to feel comfortable and I had confidence in Mr Clarke from the outset.
Mr Clarke has been most helpful to my specific situation. He made allowances for me and adapted to my particular health issues.
Mr Clarke could not have done more for me. He looked after me and made me feel important and safe.
Totally professional. Excellent patient communication skills.
Whole experience was very professional, so felt safe in his hands. Communication so important and Mr Clarke was brilliant.