Clinical management of pediatric achalasia

Abstract

Achalasia is a rare esophageal motility disorder. Much of the literature is based on the adult population. In adults, guidance of therapeutic approach by manometric findings has led to improvement in patient outcome. Promising results have been achieved with novel therapies such as PerOral Endoscopic Myotomy (POEM). Areas covered: In this review, we provide an overview of the novel diagnostic and therapeutic tools for achalasia management and in what way they will relate to the future management of pediatric achalasia. We performed a PubMed and EMBASE search of English literature on achalasia using the keywords 'children', 'achalasia', 'pneumatic dilation', 'myotomy' and 'POEM'. Cohort studies < 10 cases and studies describing patients ≥ 20 years were excluded. Data regarding patient characteristics, treatment outcome and adverse events were extracted and presented descriptively, or pooled when possible. Expert commentary: Available data report that pneumatic dilation and laparoscopic Heller's myotomy are effective in children, with certain studies suggesting lower success rates in pneumatic dilation. POEM is increasingly used in the pediatric setting with promising short-term results. Gastro-esophageal reflux disease (GERD) may occur post-achalasia intervention due to disruption of the LES and therefore requires diligent follow-up, especially in children treated with POEM.

Atelectasis: An Uncommon Sign of Achalasia in Childhoo

“…Most children are treated as GER, and this misdiagnosis leads to development of persisting symptoms, and failure to thrive (5) . When compared to children, adults are more likely to experience respiratory symptoms as biphasic stridor and/ or atelectasis because of the compression of the airway by megaesophagus (6) . Barr and et al (7) reported a case with tracheomalacia secondary to compression by megaesophagus that presented with complaints of stridor.…”

“…Moreover, existence of food and fluid in the esophagus may cause a dilated or tortuous esophagus (5) . While both clinical and radiological findings confirm achalasia, esophagus manometry is considered as the gold standard test for diagnosing and subtyping (6) . The findings supporting the diagnosis of achalasia include elevated LES pressure, the absence of LES relaxation during swallowing, or the presence of low amplitude waves featured with non-progression or absence of primary peristaltic waves (5) .…”

Acalasia Cardia en un lactante de 5 meses. Reporte de un caso

“…Las terapias farmacológicas proporcionan un alivio temporal de los síntomas y no se han recomendado en lactantes. 8 También se ha utilizado la toxina botulínica local inyectada vía endoscópica en el músculo del EEI; su principal inconveniente es que los síntomas son recurrentes en un 80% de los pacientes a los seis meses.…”

What is the role of high‐resolution oesophageal manometry in paediatrics?

“…2a; example 5), and type III (spastic achalasia) have all been described in children. [45][46][47][48] The reliability of HRM for detecting achalasia is excellent; however, subtyping of achalasia requires careful expert review. 48…”

“…The three subtypes of achalasia, type I (classic achalasia), type II (pan‐oesophageal pressurisation – see Fig. 2a; example 5), and type III (spastic achalasia) have all been described in children 45–48 . The reliability of HRM for detecting achalasia is excellent; however, subtyping of achalasia requires careful expert review 48 …”