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Abstract

We reviewed our experience in the diagnosis and management of esophageal achalasia in 33 children over a 25-year period at a single center by a retrospective chart review of all patients diagnosed with achalasia between December 1, 1975 and January 30, 2001. There were 33 cases ranging from 5 months to 16 years of age at the time of presentation (17 boys and 16 girls). Although dysphagia and vomiting were the commonest presenting symptoms, weight loss, chest pain, coughing, and recurrent pneumonia also occurred in many patients. Barium contrast study of the esophagus was the initial diagnostic modality followed by esophageal manometry. An upper endoscopy was also performed in 78.7% of cases. Management was predominantly surgical; however, seven recently diagnosed patients opted for botulinum toxin (botox) injection as the first line of treatment. The follow-up duration varied from 10 months to 10 years (mean 4.71 +/- 3.2 years). Postsurgical complications included gastroesophageal reflux disease in five patients who had not received a simultaneous antireflux procedure and "residual achalasia" in two patients, who both responded to a single botox injection.

Outcomes of treatment of childhood achalasia

“…Pathologically, achalasia is characterized by myenteric inflammation with fibrosis of myenteric nerves and loss of ganglion cells [3]. Clinically, the annual incidence of achalasia in children is 0.11 cases per 100,000 children [4, 5]. Achalasia most commonly presents with dysphagia, regurgitation, chest pain and symptoms of gastroesophageal reflux [1, 2].…”

Treatment of Gastrointestinal Sphincters Spasms with Botulinum Toxin A

“…The condition is characterized by an incomplete relaxation or by a lack of coordination of the UES [ 22 , 41 ]. CPA is a different entity then the CP dysphagia that was see in adults.…”

“…Immaturity of the interstitial cells of Cajal may explain why there have been reports of spontaneous resolution of CPA seen in infants [ 42 ]. CPA has also associated with gastro-esophageal reflux disease and CNS abnormalities [ 21 , 22 , 41 , 42 , 43 , 44 ].…”

Peroral Endoscopic Myotomy in Diffuse Thickened Esophageal Wall in an Adolescent

“…Achalasia is an extremely rare pathology in children and occurs at a frequency of 0.02–0.11 per 100,000 children; however, it is a cause of delay in physical and mental development [ 1 , 2 ]. Heller's procedure is widely used to manage this disease.…”