2011 update on esophageal achalasia

Chuah, Seng‐Kee; Hsu, Pin‐I; Wu, Keng‐Liang; Wu, Deng-Chyang; Tai, Wei‐Chen; Changchien, Chi‐Sin

doi:10.3748/wjg.v18.i14.1573

Cited by 51 publications

(38 citation statements)

References 63 publications

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“…Endoscopy is avoided in younger children as barium studies shows ample evidence of underlying aetiology. [3] Management has got different options as medical, endoscopic, pneumatic dilatation and surgical. Calcium channel blockers like nifedipine is used for the relaxation of LES but the results are not that encouraging compare to other managements.…”

Section: Discussionmentioning

confidence: 99%

Childhood Achalasia: Barium Swallow is Gold Standard Even Before Histological Confirmation –Case Report

Sharma¹,

Sharma²,

Bhardwaj³

et al. 2017

Ann. Int. Med. Den.Res.

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Achalasia in pediatric age group is rare and the causative aetiology is neurodegeneration of the neuro-myenric plexus at the lower oesophageal sphincter (LES). This may not be diagnosed properly because of inherent problems for the investigations in children. We present 14-years old boy who had been having frequent retrosternal chest pain with off and on vomiting of three years duration. There was no relief by the antacids and other symptomatic medication. He underwent barium swallow for the study of oesophagus and was diagnosed to be having oesophageal achalasia.

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Section: Discussionmentioning

confidence: 99%

Childhood Achalasia: Barium Swallow is Gold Standard Even Before Histological Confirmation –Case Report

Sharma¹,

Sharma²,

Bhardwaj³

et al. 2017

Ann. Int. Med. Den.Res.

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“…Maksimak et al [9] reported 4 children treated with nifedipine before meals who reported relief of symptoms likely related to a decrease in resting LES pressure. In either children or adults, nifedipine is not a definitive therapy and should only rarely be used as a bridge to relieve symptoms until pneumatic dilatation, Botox injection or myotomy can be performed [5,10] .…”

Section: Medical Therapymentioning

confidence: 99%

“…Partial relaxations are common and normal relaxations may also be present on manometry according to Morea et al [8] . Upper endoscopy and biopsy is reasonable to rule out esophagitis, Trypanosoma cruzi, malignancy, and other secondary causes of achalasia [1,4,5] . Our institutional protocol for work up consists of a barium swallow study, upper endoscopy, and endoscopic biopsy.…”

Section: Diagnosismentioning

confidence: 99%

“…Nifedipine, a calcium channel blocker, inhibits the trans membrane calcium influx in cardiac and smooth muscle and has been primarily used to treat achalasia in adults [5] . In children, the use of nifedipine has not been well studied.…”

Section: Medical Therapymentioning

confidence: 99%

“…The pathophysiologic basis of achalasia is characterized by the degeneration of the inhibitory myenteric plexus that innervates the lower esophageal sphincter (LES) and esophageal body [4] . This leads to an imbalance in the inhibitory and excitatory neurons resulting in the failure of the LES to relax with swallowing, absence of peristalsis of the esophageal body, and increased LES resting pressures [5] . Goldblum et al [6] found a depletion or absence of myenteric ganglion cells, destruction of myenteric nerves, and chronic myenteric inflammation in 42 esophageal specimens.…”

Section: Introductionmentioning

confidence: 99%

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Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

111

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Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.

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Achalasia cardia: A case report in young female

Subedi,

Parajuli,

Bista

et al. 2024

Clinical Case Reports

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Key Clinical MessageThis case emphasizes the need for early recognition and accurate diagnosis of achalasia in young adults to avoid exacerbation of the condition and misdiagnosis as GERD. Patient outcomes and quality of life are greatly enhanced by suitable diagnostic techniques, appropriate therapy, interdisciplinary care, and comprehensive patient education along with frequent follow‐ups.AbstractAchalasia results from the degeneration of inhibitory ganglion cells within the esophageal myenteric plexus and the lower esophageal sphincter (LES), leading to a loss of inhibitory neurons and resulting in the absence of peristalsis with failure of LES relaxation. Its origins are multifactorial, potentially involving infections, autoimmune responses, and genetics, with equal incidence in males and females. The hallmark symptoms include progressive dysphagia for solids and liquids, along with regurgitation, heartburn, and non‐cardiac chest pain. A 22‐year‐old female patient initially diagnosed with gastroesophageal reflux disease (GERD) received proton pump inhibitors and antacid gel for persistent dysphagia and regurgitation. Subsequent tests including barium esophagogram and manometry indicated Type II Achalasia Cardia. The patient showed clinical improvement with relief of dysphagia, regurgitation, and heartburn symptoms after pneumatic balloon dilatation (PBD). She was advised to follow up after 6 months with upper gastrointestinal (UGI) endoscopy and manometry in the outpatient clinic for regular endoscopic surveillance as there is a risk of transformation to esophageal carcinoma. Diagnosing achalasia in young adults poses challenges due to its diverse presentation and resemblance to other esophageal disorders like GERD. Diagnosis relies on clinical symptoms and imaging studies such as barium esophagogram revealing a bird's beak appearance and esophageal manometry showing absent peristalsis. UGI endoscopy is needed to rule out malignancy. Treatment options include non‐surgical approaches like medication and Botox injections, as well as surgical methods such as pneumatic balloon dilation, laparoscopic Heller myotomy, and per‐oral endoscopic myotomy (POEM). The treatment options depend upon the patient's condition at presentation and their individual choices. This case report emphasizes that it is crucial to consider achalasia as a potential differential diagnosis in young adults with dysphagia, especially if conventional treatments for acid peptic disorder do not alleviate symptoms. Prompt diagnosis and appropriate management can lead to significant clinical improvement and better patient outcomes.

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2011 update on esophageal achalasia

Cited by 51 publications

References 63 publications

Childhood Achalasia: Barium Swallow is Gold Standard Even Before Histological Confirmation –Case Report

Childhood Achalasia: Barium Swallow is Gold Standard Even Before Histological Confirmation –Case Report

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Achalasia cardia: A case report in young female

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