Etiology and Treatment of Achalasia in the Pediatric Age Group

Laparoscopic extended cardiomyotomy in children: an effective procedure for the treatment of esophageal achalasia

“…In childhood, achalasia is a very rare idiopathic disorder of esophageal motility, with symptoms that can be confused with more common conditions, such as failure to thrive, gastroesophageal reflux, or even psychiatric eating disorders [13]. Unfortunately, a delay in the correct diagnosis and nutritional status impairment may occur, as we could see in our series, with a mean time of almost 3 years from the beginning of the symptoms to the correct diagnosis of achalasia.…”

“…Recurrence of symptoms, especially dysphagia, has been reported in incidences varying from 0 to 27%, in both the pediatric and adult literature [8,16,17,19]. Some authors postulate that the length of esophagomyotomy should be between 4 and 6 cm on the esophageal side and must not exceed 1 cm onto the stomach [13]. They assume that preservation of an effective lower esophageal sphincter is important to prevent postoperative reflux [20].…”

Minimally invasive Heller's myotomy in children: safe and effective

“…It affects both the LES and smooth musculature of the esophagus and is thought to result from smooth muscle denervation [3]. The diagnosis of achalasia can be difficult in children as the symptoms can be confused with feeding aversion, failure to thrive, or gastroesophageal reflux [4]. However, in patients older than 5 years, the clinical presentation is very similar to adults, as follows: vomiting, dysphagia, weight loss, recurrent pneumonia, failure to thrive, or nocturnal cough.…”

“…The earlier the obstruction can be relieved by myotomy or other means, the less likely the patient will need to progress to esophagectomy [5]. Medical treatment has been attempted in the form of calcium channel blockers and nitrates, with minimal effect, especially in children, and this therapy is only recommended for short-term symptomatic relief pending definitive surgical treatment [4].…”

Intraoperative manometry during laparoscopic Heller myotomy improves outcome in pediatric achalasia

“…Diagnosis is established by upper endoscopy, esophageal manometry, and upper gastrointestinal contrast radiography (esophogram). Treatment modalities for achalasia have included modifications in diet, oral medications (calcium channel blockers, nitrates, and nitroglycerin), and injection of botulinum toxin in the LES; however, the most successful interventions are pneumatic dilation or surgical esophagocardiomyotomy (Heller myotomy) [5][6][7]. Several recent studies in large series of adult patients and smaller cohorts of children have demonstrated that surgical intervention results in the most effective and durable treatment [8][9][10]; however, Heller myotomy has not been universally successful with treatment failures attributed to inadequate length of myotomy and persistence of residual high-pressure zones at the LES.…”