Dr. Conor McCann
Achalasia and gastroparesis
Think about the last time you ate a sandwich. You chewed it, savoured it and then swallowed it: job done. We tend to forget about the food we eat as soon as we swallow it but for some people the journey of the food down the gullet, into the stomach, and onwards into the small intestine can be more challenging.
When we swallow, the gullet contracts at regular intervals, creating a wave-like movement that pushes the food forward. This process is called peristalsis. Once the food enters the stomach, the walls of the stomach contract to churn the food, mixing it with the gastric juices that help to break the food down. Once churned into a smooth liquid, the food enters the small intestine slowly, where it gets broken down further and absorbed into the bloodstream.
Unfortunately in some people these contractions do not work well. Achalasia and gastroparesis are two conditions that cause the progress of the food through the gut to slow down or stop.
Achalasia is characterised by faulty peristalsis, the wave-like movement in the gullet, leading to food getting stuck there. People affected can experience difficulty swallowing, vomiting, heartburn, and pain. In gastroparesis the walls of the stomach do not contract properly, which means that food stays in the stomach for longer, leading to a feeling of fullness, nausea, vomiting, bloating, acid reflux, and pain.
Both conditions can cause loss of appetite, leading to unintentional weight loss and nutritional problems. They can also make people feel very unwell and decrease their quality of life. At present there are no cures for either condition, with treatment limited to drugs or surgery to alleviate symptoms.
It is not clear what causes either condition, but it seems damage to nerve cells in the gullet and the stomach might be involved. These nerve cells are responsible for stimulating the muscles that contract to squeeze the gullet and the stomach. Damaged caused by poorly controlled diabetes to nerve cells can be a cause of gastroparesis (diabetic gastroparesis). Gastroparesis in turn can make controlling diabetes much harder, by slowing down the emptying of the stomach and affecting the levels of sugar (glucose) that reach the blood.
Guts UK are currently funding a three-year Fellowship for £210,000 to Dr Conor McCann at University College London. Dr McCann is investigating whether those damaged nerve cells can be replaced and by doing this, restore appropriate muscle contraction in the gullet or the stomach. If he is successful, we might be able to treat achalasia and diabetic gastroparesis in the future by injecting new nerve cells into the relevant part of the gut, to restore its function.
Condition such as achalasia and gastroparesis that affect the upper part of the gut (upper gastrointestinal, or upper GI) are a priority for Guts UK. We fund research in this area via our Guts UK Derek Butler Fellowship, which is the award that Dr McCann received. We have also launched a new Fellowship with Olympus exploring how best to use endoscopy to diagnose and manage other upper GI conditions, namely Barrett’s Oesophagus and Gastroesophageal Reflux Disease (acid reflux).
If you are interested in supporting our work in upper GI conditions, which is hugely important, please donate to our ‘Upper GI Fund’.Click here to donate