Clinical Management of Pediatric Achalasia

Lennep, Marinde van; Wijk, Michiel P. van; Omari, Taher; Salvatore, Silvia; Benninga, Marc A.; Singendonk, Maartje

doi:10.1097/mpg.0000000000002221

Cited by 27 publications

(25 citation statements)

References 31 publications

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“…The safety and short-term efficacy of POEM has been established in adult patients with achalasia as well as nonachalasia spastic motility disorders of the esophagus. In pediatric cases with achalasia, Heller's myotomy and pneumatic dilatation are the preferred treatment modalities (13). Emerging data suggest that POEM is an effective alternative to pneumatic dilatation and Heller's myotomy in pediatric achalasia as well (6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

et al. 2022

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Background and AimPer-oral endoscopic myotomy (POEM) is emerging as an effective treatment for pediatric achalasia. There are limited data on the long-term efficacy of POEM in children and adolescents with achalasia. In this study, we aim to evaluate the outcomes of POEM at ≥4 years follow-up.MethodThe data of consecutive children who underwent POEM (September 2013–July 2021) and completed at least 4 years follow-up were analyzed retrospectively. The primary outcome was clinical success (Eckardt ≤ 3) at ≥4 years follow-up. The secondary outcomes included the prevalence of gastroesophageal reflux disease (GERD) and predictors of recurrent symptoms (Eckardt ≥2) after POEM.ResultsA total of 69 children underwent POEM for achalasia during the study period. Of these, 41 (59.4%) children completed ≥4 years [mean 68.5 months (range 48–94)] follow-up, and 38 were included in the final analysis. The subtypes of achalasia included type I (28.9%), type II (60.5%), and type III (2.6%). There was a history of prior treatment in 11 children (28.9%). Clinical success was recorded in 36 (94.7%) patients who successfully underwent POEM. Recurrent symptoms (Eckardt ≥ 2) were noticed in 12 (31.6%) children at ≥4 years. On multivariate analysis, there were no identifiable factors which predicted recurrent symptoms after POEM. Symptomatic GERD and erosive esophagitis were detected in 13.8% (4/29) and 57.1% (8/14) of the children, respectively.ConclusionPOEM is a durable treatment modality for achalasia in the pediatric population irrespective of the sub-type of achalasia and history of prior treatment.

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Section: Discussionmentioning

confidence: 99%

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

et al. 2022

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“…Esophagocardiomyotomy can be performed by an abdominal or thoracic approach, but the abdominal approach is preferrable because of possibility of performing the antireflux procedure. Myotomy is followed by partial gastric fundoplication in order to reduce the incidence of postoperative GER (from 13% to 7%), although some authors consider it unnecessary [6]. Myotomy with fundoplication have higher success rate comparing to myotomy alone (91%:73%) [7].…”

Section: Discussionmentioning

confidence: 99%

Esophageal achalasia in a two-year-old boy

et al. 2020

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Introduction. Esophageal achalasia is a neurodegenerative motility disorder, which is characterized by ineffective or absent esophageal peristalsis and the lack of hypertonic lower esophageal sphincter relaxation. Achalasia causes failure to thrive in children and can have serious respiratory complications. Achalasia is a very rare condition in pediatric population, and usually misdiagnosed as gastroesophageal reflux. The treatment of choice is Heller esophagocardio-myotomy. The aim of this paper is to present a rare case of a two-year-old child with achalasia, diagnostic procedures, and successful operative treatment. Case outline. The patient?s problems started at the age of six months, with audible breathing and respiratory stridor. The child was admitted at a local hospital at seven months of age, dismissed with dietary advices, again admitted at the age of 19 months, and transferred to our institution. Upper gastrointestinal series and computed tomography revealed findings characteristic for achalasia, and on esophagoscopic exam there was no opening of lower esophageal sphincter and cardia on insufflation. Pneumatic dilation was performed with temporary improvement. Laparotomic Heller esophagocardiomyotomy with Dor partial fundoplication was successfully performed. Conclusion. Achalasia is a very rare condition in infants and small children. There is often a delay in establishing the correct diagnosis. Upper gastrointestinal series and endoscopic exam are most reliable methods to detect achalasia. Pharmacological treatment, intrasphincteric injection of botulinum toxin and pneumatic dilations are not efficient methods, especially in small children. The method of choice in the treatment of achalasia is Heller esophagocardiomyotomy with partial fundoplication.

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“…Food bolus impaction points toward the diagnosis of EoE (24). The combination of bolus regurgitation, chest pain, weight loss, and paradoxical dysphagia constitute the typical presentation of achalasia (30,31).…”

Section: Associated Symptomsmentioning

confidence: 99%

Esophageal Dysphagia in Children: State of the Art and Proposal for a Symptom-Based Diagnostic Approach

Lanzoni

Sembenini²,

Gastaldo³

et al. 2022

Front. Pediatr.

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Pediatric esophageal dysphagia (PED) is an infrequent condition that can be determined by a large number of disorders. The etiologic diagnosis is challenging due to overlapping clinical phenotypes and to the absence of pediatric diagnostic guidelines. This review aims to summarize the most relevant causes of ED during childhood, highlight the clinical scenarios of PED presentation and discuss the indications of available diagnostic tools. Available information supports that PED should always be investigated as it can underlie life-threatening conditions (e.g., foreign body ingestion, mediastinal tumors), represent the complication of benign disorders (e.g., peptic stenosis) or constitute the manifestation of organic diseases (e.g., eosinophilic esophagitis, achalasia). Therefore, the diagnosis of functional PED should be made only after excluding mucosal, structural, or motility esophageal abnormalities. Several clinical features may contribute to the diagnosis of PED. Among the latter, we identified several clinical key elements, relevant complementary-symptoms and predisposing factors, and organized them in a multi-level, hierarchical, circle diagram able to guide the clinician through the diagnostic work-up of PED. The most appropriate investigational method(s) should be chosen based on the diagnostic hypothesis: esophagogastroduodenoscopy has highest diagnostic yield for mucosal disorders, barium swallow has greater sensitivity in detecting achalasia and structural abnormalities, chest CT/MR inform on the mediastinum, manometry is most sensitive in detecting motility disorders, while pH-MII measures gastroesophageal reflux. Further studies are needed to define the epidemiology of PED, determine the prevalence of individual underlying etiologies, and assess the diagnostic value of investigational methods as to develop a reliable diagnostic algorithm.

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Clinical Management of Pediatric Achalasia

Cited by 27 publications

References 31 publications

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

POEM Is a Durable Treatment in Children and Adolescents With Achalasia Cardia

Esophageal achalasia in a two-year-old boy

Esophageal Dysphagia in Children: State of the Art and Proposal for a Symptom-Based Diagnostic Approach

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