After ACHALASIA keyhole Surgery

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Tuesday February 22,2011

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Tim Noble was unable to swallow for 20 years

CHRISTINE FIELDHOUSE hears how a pioneering operation saved Tim Noble from a rare condition  which left him unable to swallow

EVERY time Tim Noble tucks into a cheese sandwich he relishes the experience as much as if he were enjoying a three-course gourmet meal. Eating is still a novelty for 38-year-old Tim, who had almost 20 years of tests and treatments just to enable him to swallow his food. At his worst he was 3st underweight and barely able to swallow water.“I’m sure some people thought I must be anorexic or a drug addict because I was so thin,” says Tim, from Darlington in Co Durham. “I really thought I would die from choking on food. In my early 30s I didn’t expect to make it to 40.”Tim was 15 and drinking a can of cola with friends when he first experienced the sensation of being unable to swallow.

“I had to spit the drink out because there was no way it would go down,” recalls Tim, a customer services representative. “My mates took the mickey but I just thought it was a one-off.” As the months went by Tim became unable to swallow any fizzy drinks and soon solids such as chicken, cheese and bacon started to get stuck in his throat.Even trying to force them down with up to four pints of water per meal didn’t always work and he often ended up coughing and spluttering at meals.“My mum was worried I was going to choke,” says Tim. “I could see the panic on her face when I couldn’t speak or explain.“I left a lot of meals because I couldn’t swallow any of the food.“I was also starting to date girls yet I couldn’t take them to dinner. It was embarrassing that people thought I was being sick when I was just trying to swallow.”

As well as advising Tim to chew his food more his GP prescribed drugs such as cimetidine to stop the food regurgitating.“Nothing seemed to work. People thought I was imagining the whole thing,” says Tim.

At 18 he was referred to Darlington Memorial Hospital for treatment but it wasn’t until three years later that the cause of the problem was discovered.Tim was given a gastroscopy test, in which a thin, flexible telescope with a tiny camera is passed through the mouth and throat so doctors can examine the upper part of the gut.The specialist couldn’t get the endoscope through the muscle between Tim’s oesophagus (gullet) and his stomach.

His condition is called achalasia cardia, where the smooth muscle layer in the oesophagus is unable to move food down the gullet through the lower oesophageal sphincter.

By this stage Tim weighed 9st, too light for his 5ft 10in height, and his diet consisted of “sloppy” foods such as lasagne and beans which he tried to force down with mouthfuls of air and liquids.

Tim’s doctors decided the muscle in his oesophagus needed to be dilated to permanently widen it. The first dilation was a success and enabled Tim to eat normally for a fortnight but the muscle narrowed again and the problem returned.

“I had about 10 procedures, each one lasting less time than the previous one. The final one lasted until I’d reached my car in the hospital car park,” he says.Other treatments, including using Botox in the hope it would relax the area between the gullet and the stomach, also failed.By 35 Tim’s condition was so bad he had barely any energy left after work for anything other than sitting at home watching television with his partner Sue.“All the techniques I’d used over the years, gulping air or water to make the food go down, weren’t working now. I had accepted that I would never swallow properly again.”Tim was finally referred privately to Mr Yirupaiahgari Viswanath, a consultant and laparoscopic surgeon at the Nuffield Health Tees Hospital in Norton, Stockton-on-Tees.

In July 2008, under general anaesthetic, Tim had a keyhole laparoscopic cardiomyotomy. The weakened muscle in the oesophagus was split to relax the junction which links the stomach and gullet. To prevent the food coming back up Mr Viswanath reinforced the “valve” between Tim’s oesophagus and stomach by wrapping the upper part of the stomach around the lowest part of the oesophagus. According to Mr Viswanath, there are around 6,000 patients diagnosed with achalasia cardia in the UK every year.

Conventional treatment is still medication and dilatation of the junction between the stomach and the oesophagus. Only “a few hundred” have had Tim’s operation.

THE £3,000 operation not only gave Tim the ability to enjoy his food for the first time since his teens but also the energy to exercise and have a social life.

“After three months of healing which involved eating ice cream and puréed foods I introduced chunkier foods and found I could swallow them,” says Tim. “From then on I made up for all those years of not eating by enjoying takeaways and Sunday dinners and I piled on weight. It was great to have some energy at last so I joined a gym.”

Since the operation, which is also available on the NHS, Tim has taken part in two 10k runs, the Great North Run and a half marathon. He has also taken part in the Tough Guy challenge, an extreme obstacle course.

“I don’t associate food with pain any more and I’ve rediscovered eating,” he says.