Slide 1: Which disease was historically treated with a whale bone?

Slide 2: Achalasia! Achalasia is a disease characterized by loss of inhibitory neurons in the myenteric plexus of the esophagus. Graphic showing normal physiology of the myenteric plexus and inhibition of esophageal contraction.

Slide 3: Some theorize achalasia may be autoimmune in nature, related to molecular mimicry following an HSV-1 infection. Graphic showing pathophysiology. An autoimmune insult to the myenteric plexus leads to uninhibited contraction of the esophagus.

Surgical management is the standard-of-care for achalasia treatment. Options include open surgery (Heller myotomy), endoscopic surgery, or ballon dilation.

Slide 4: Historically, dilation was once performed with a whale bone, as early as 1697. Sir Thomas Willis was the first to popularize this, pushing down lodged food with a sponge-tipped bone. Graphic showing a whale bone being used to dilate the esophagus.


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  • Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013 Aug;108(8):1238-49. PMID 23877351.
  • Nanson EM. Treatment of achalasia of the cardia. Gastroenterology. 1966 Aug;51(2):236-41. PMID 5947505.

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