Cricopharyngeal achalasia in children: Botulinum toxin injection as a tool for diagnosis and treatment

Scholes, Melissa A.; McEvoy, Timothy P.; Mousa, Hayat; Wiet, Gregory J.

doi:10.1002/lary.24464

Cited by 34 publications

(27 citation statements)

References 16 publications

(41 reference statements)

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“…32 Therapies for such esophageal abnormalities, however, are sparse. 33,34 Despite these limitations, the GI aerodigestive evaluation objectively defined gastrointestinal tract anomalies, evaluated symptom correlation, and found histologic abnormalities. In this cohort, GI providers were often able to wean children off of their acid suppressing medications.…”

Section: Resultsmentioning

confidence: 99%

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Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

DeBoer

Kinder

Duggar

et al. 2018

Pediatric Pulmonology

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Objective To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH‐MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results Mean patient age was 3.15 years (range 0.15‐24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH‐MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH‐MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH‐MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. Conclusions Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH‐MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.

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Section: Resultsmentioning

confidence: 99%

“…Our center also does not routinely perform esophageal motility studies, but altered esophageal or pharyngeal motility is found in other disorders such as TEF/EA and cricopharyngeal achalasia in the aerodigestive population . Therapies for such esophageal abnormalities, however, are sparse …”

Section: Discussionmentioning

confidence: 99%

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

DeBoer

Kinder

Duggar

et al. 2018

Pediatric Pulmonology

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“…Cricopharyngeal achalasia (CPA) is an uncommon cause of oropharyngeal dysphagia (OPD) especially in children and it was first described in children by Utian and Thomas in 1967. 1,2 CPA is caused by failure of the upper esophageal sphincter (UES) to relax for a bolus during swallowing. 1,3 The cricopharyngeal muscle (CPM) which is the main component of UES is tonically contracted at rest and relaxes during normal swallowing to enable airway protection and propulsion of food bolus.…”

Section: Abstract: Cricopharyngeal Achalasia Dysphagia High Resolumentioning

confidence: 99%

“…1,2 CPA is caused by failure of the upper esophageal sphincter (UES) to relax for a bolus during swallowing. 1,3 The cricopharyngeal muscle (CPM) which is the main component of UES is tonically contracted at rest and relaxes during normal swallowing to enable airway protection and propulsion of food bolus. 4,5 The failure of relaxation leads to inability to swallow and increases risk for aspiration of residual food in pharynx.…”

Section: Abstract: Cricopharyngeal Achalasia Dysphagia High Resolumentioning

confidence: 99%

Assessment of pediatric cricopharyngeal achalasia with high resolution manometry

et al. 2019

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“…cerebral palsy, muscular dystrophy, mitochondrial encephalomyopathy, Arnold-Chiari malformation (10,11).…”

Section: Introductionmentioning

confidence: 99%

Cricopharyngeal achalasia in connection with autoimmune disorders in a pre-adolescent patient: a case report

2017

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Cricopharyngeal achalasia is an uncommon cause of dysphagia, especially in children. Congenital form is known in neonates and infants. In older children this disease has been reported in very rare cases and mostly in connection with neurological and muscular diseases. We present a case of a 12-year-old girl with a four-year history of dysphagia. Esophagogastroduodenoscopy, radiological contrast swallow study and esophageal manometric study confirmed the diagnosis of cricopharyngeal achalasia. The patient was successfully treated with dilatation of the upper esophageal sphincter. An initial attempt of dilatation appears to be a safe and effective option in the management of cricopharyngeal achalasia in children, and may prevent or at least postpone the need for myotomy. Following the diagnosis of cricopharyngeal achalasia, several autoimmune conditions were diagnosed. Our case report revealed that cricopharyngeal achalasia may occur in association with some other autoimmune conditions, and that autoimmunity may also play a role in cricopharyngeal achalasia itself. IzvlečekKrikofaringealna ahalazija je pri otrocih izjemno redek razlog za disfagijo. Poznana je kongenitalna oblika krikofaringealne ahalazije pri novorojenčkih in dojenčkih, pri starejših otrocih pa so to bolezen doslej opisali zelo redko in večinoma v povezavi z nevrološkimi in mišičnimi boleznimi. V prispevku prikazujemo primer 12-letne deklice s štiriletno anamnezo disfagije. Z ezofagogastroduodenoskopijo, radiološko preiskavo požiranja s kontrastom in ezofagealno manometrijo smo potrdili diagnozo krikofaringealna ahalazija. Bolnico smo uspešno zdravili z dilatacijo zgornjega ezofagealnega ustja. Začetni poizkus zdravljenja z dilatacijo se zdi varna in učinkovita metoda zdravljenja krikofaringelane ahalazije pri otrocih in lahko prepreči ali vsaj odloži potrebo po miotomiji. Po postavitvi diagnoze krikofaringealna ahalazija smo pri bolnici diagnosticirali več avtoimunskih motenj. Opisan primer prikazuje povezavo pojava krikofaringelane ahalazije z avtoimunskim dogajanjem in možnost, da bi lahko bil tudi avtoimunski proces eden od razlogov za pojav krikofaringealne ahalazije.

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Cricopharyngeal achalasia in children: Botulinum toxin injection as a tool for diagnosis and treatment

Abstract: 4.

Cited by 34 publications

References 16 publications

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Assessment of pediatric cricopharyngeal achalasia with high resolution manometry

Cricopharyngeal achalasia in connection with autoimmune disorders in a pre-adolescent patient: a case report

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