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.
- Facco M, Brun P, Baesso I, Costantini M, Rizzetto C, Berto A, Baldan N, Palù G, Semenzato G, Castagliuolo I, Zaninotto G. T cells in the myenteric plexus of achalasia patients show a skewed TCR repertoire and react to HSV-1 antigens. Am J Gastroenterol. 2008 Jul;103(7):1598-609. PMID 18557707.
- 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.
Tags: achalasia, autoimmune, esophagus, HSV-1, molecular mimicry, myenteric plexus, trivia tuesday