Issue 5 Stories
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For nearly a year, Teresa Cook lived with nagging, progressively worsening heartburn. When her condition eventually led to a constant sore throat and difficulty keeping food down, she knew it was time to seek medical care.

“I couldn’t eat,” says Cook, 53, of Moorefield, W.Va. “Food just seemed to get stuck in my esophagus. And when I would lie down, it would all come back up. Our family likes to go to restaurants, and due to my difficulty with eating, we couldn’t do that for a number of months.”

Finding Answers

Cook first sought help from a physician in Roanoke, Va., who performed numerous tests, including a barium swallow, also known as an esophagram, and an endoscopy, in which a thin, flexible tube with a tiny camera on the end is used to inspect the interior walls of the esophagus. She also underwent an esophageal manometry study, which measures the function of the muscles in the esophagus. The tests revealed that Cook had achalasia, a condition in which the muscles in the lower segment of the esophagus, where it joins with the stomach, fail to completely relax. This persistent spasm, or tightening, of the muscle prevents food and liquids from passing out of the esophagus and into the stomach.

Achalasia is a rare disease, diagnosed in about 3,000 people—primarily adults, but also children— in the U.S. each year. Left untreated, the increasing difficulty patients experience in swallowing food and liquids can lead to severe weight loss and malnutrition. The cause of achalasia is unclear, but the condition may be linked to cancers of the lungs or abdominal area, or it could be caused by an infection.

POEM: A New Treatment Option

Following her diagnosis, Cook was referred to interventional gastroenterologist Alan Brijbassie, MD, who joined Sentara Martha Jefferson in July 2016, bringing with him an array of advanced endoscopic treatments for esophageal diseases. In December, Cook became the first patient at the hospital to undergo peroral endoscopic myotomy (POEM), a relatively new, minimally invasive procedure to treat achalasia.

During the POEM procedure, which is performed under general anesthesia, the surgeon inserts an endoscope through the mouth and into the esophagus, enabling viewing of the esophagus and stomach on a small monitor. Once the endoscope is in place, the surgeon makes a tiny incision in the lining of the esophagus, creating an opening that provides access to the esophageal muscle. A small section of the muscle is then removed, helping to loosen up the remaining tissue.

“Relieving the tension in the muscle allows the patient to swallow much better,” Dr. Brijbassie explains. “Because the procedure doesn’t require an incision on the outside of the body, patients heal much more quickly. This allows them to leave the hospital sooner and return home with their quality of life restored.”

After the procedure, Cook—who had lost nearly 30 pounds in the five months prior to treatment—stayed in the hospital overnight for observation. The next morning, Dr. Brijbassie ordered one more barium swallow test to ensure that the surgery had been successful, and then Cook was able to go home.

Expanding to Meet Community Healthcare Needs

Sentara Martha Jefferson is one of just two medical centers in Virginia—and one of just a small number throughout the country—to offer the POEM procedure. Providing this new treatment option is in line with Sentara’s commitment to meeting the ever-growing healthcare needs in the Central Virginia region and beyond.

“With so many people in our area suffering from gastrointestinal issues, it’s significant that Sentara is committed to offering the most advanced and effective therapies for gastrointestinal diseases,” Dr. Brijbassie says. “I hope patients in the region will be drawn to us not only for our expertise in treating these conditions, but also for the compassionate, personalized care we provide.”

Cook, who works as a teacher’s aide and substitute cook for a local school, and also for an appraisal group, has been able to return to the activities she enjoys. She still takes a prescription medication to prevent heartburn, but now she rarely needs the over-the-counter heartburn medication she had become accustomed to taking regularly prior to undergoing the POEM procedure.

“I can swallow and eat just fine now,” Cook says. “I feel great. I really loved Dr. Brijbassie. He came in and told me what he was going to do every step of the way. He even drew pictures for me to explain what was going to happen. He was really to the point, and I appreciated that.”

For others experiencing chronic heartburn, Cook says: “Don’t fool around with it. If you experience heartburn that keeps getting worse, then something more serious may be going on. It’s important to have it checked out, and I’d recommend Sentara Martha Jefferson and Dr. Brijbassie to anyone.”

More Options for Patients With Diseases of the Digestive Tract

Sentara Martha Jefferson Hospital is committed to providing the most advanced services available to provide relief for patients with gastrointestinal disorders. Interventional gastroenterologist Alan Brijbassie, MD, joined Sentara Martha Jefferson last summer, bringing expertise in a variety of new treatment options for patients with diseases of the hepatobiliary system, which comprises the liver, gall bladder and bile ducts.

One such procedure, endoscopic retrograde cholangio-pancreatography, uses a combination of X-ray and endoscopy to diagnose and treat problems in the liver, gall bladder and pancreas. Dr. Brijbassie also is experienced in endoscopic ultrasound (EUS), which allows doctors to see organs, such as the pancreas and liver, that aren’t visible with endoscopy alone. EUS may be used in combination with a technique known as fine-needle aspiration to biopsy certain internal organs, as well as for tumor staging and stent placement to relieve blockages. In addition, Dr. Brijbassie offers nonsurgical removal of lesions in the digestive tract, from the esophagus to the rectum.

“The services I provide may be considered a bridge between general gastroenterology and surgery,” says Dr. Brijbassie, whose patients are typically referred by general gastroenterologists for advanced interventional care. “Sometimes I am able to help patients avoid having surgery. But when they do need it, I collaborate with their surgeons to provide the best care possible. At Sentara Martha Jefferson, patients have access to the most advanced equipment and procedures to take care of their advanced digestive problems.”

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