Diagnosis, misdiagnosis, and associated diseases of achalasia in children and adolescents: a twelve-year single center experience

Hallal, Cristiane; Kieling, Carlos Oscar; Nunes, Dulce Maria; Ferreira, Cristina Targa; Peterson, Guilherme Eckert; Barros, Sérgio Gabriel Silva de; Arruda, Cristina Antonini; Fraga, José Carlos Soares de; Goldani, Helena Ayako Sueno

doi:10.1007/s00383-012-3214-3

Cited by 94 publications

(64 citation statements)

References 31 publications

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“…AD is a motor disorder that is charac¬terized by the absence of esophageal peristalsis and by incomplete relaxation of the lower esophageal sphincter [4]. The most common symptoms in children and adolescents are vomiting, progressive dysphagia, and weight loss [5]. Our patient with growth and developmental retardation had vomiting which lasted for 3 years.…”

Section: Discussionmentioning

confidence: 80%

First Identified Case in Literature: Association of Achalasia and Celiac Diseases

Bucak¹

2016

Ann Clin Anal Med

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ÖzetÇölyak hastalığında ösefagus sfinkterinde gevşeme ve mide boşalma zamanın-da uzama gibi gastrointestinal sistem problemleri görülmektedir. Akalazya hastalığı ösefagus peristaltizminde yokluk ve alt ösefagus sfinkterinde inkomplet gevşeme ile karakterize motor bir bozukluktur. Akalazya ve çölyak hastalıkları birlikteliği daha önce rapor edilmemiştir. Hastamızın son üç yıldır olan, büyüme ve geliş-mesini etkileyen kusmaları mevcut idi. Hastamızda çölyak hastalığı tanısı serolojik ve histopatolojik olarak koyuldu aynı zamanda akalazya hastalığı ise ösefagos-kopik muayene, üst gastrointestinal sistem kontrast çalışması ve ösefageal manometri ile koyuldu. Ösefageal balon dilatasyonu olguya uygulandı. Bu olgu ilginç birliktelik nedeniyle sunuldu. Anahtar KelimelerAkalazya Hastalığı; Çölyak Hastalığı; Kusma AbstractCeliac disease has been shown to cause problems related to gastrointestinal system motility such as reduction of the esophageal sphincter pressure and prolongation of gastric emptying time. Achalasia disease is a motor disorder that is charac¬terized by the absence of esophageal peristalsis and by incomplete relaxation of the lower esophageal sphincter. Association of achalasia and celiac diseases has not been reported yet. Our patient with growth and developmental retardation had vomiting effects which lasted for 3 years. Celiac disease was diagnosed serologically and histopathologically in our patient; we determined achalasia disease with esophagoscopic examination, upper gastrointestinal system contrast study, and esophageal manometer. Esophageal balloon dilatation was applied. This case is presented because of the interesting association between celiac disease and achalasia disease.

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Section: Discussionmentioning

confidence: 80%

First Identified Case in Literature: Association of Achalasia and Celiac Diseases

Bucak¹

2016

Ann Clin Anal Med

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“…3,4 Older children usually present with typical symptoms like dysphagia and vomiting, whereas younger children and infants often present with atypical symptoms like recurrent pneumonia, feeding difficulties, and cough. 5 The treatment options for achalasia cardia in the pediatric population include medical (calcium channel blockers, nitrates), endoscopic (botulinum toxin injection and pneumatic balloon dilatation [PBD]), and surgical (laparoscopic Heller's cardiomyotomy) treatments. However, except for PBD and laparoscopic Heller's myotomy (LHM), experience and efficacy of other therapies is limited in children.…”

Section: Introductionmentioning

confidence: 99%

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Nabi

Ramchandani

Reddy

et al. 2016

J Neurogastroenterol Motil

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Background/AimsAchalasia cardia (AC) is a motility disorder, characterized by impaired lower esophageal sphincter relaxation and absence of esophageal peristalsis. AC is rare in children with unclear optimum management strategies. Per oral endoscopic myotomy (POEM) is a novel technique for management of achalasia with encouraging results in adult patients. The efficacy and safety of POEM is not known for pediatric AC. The aim of our study was to evaluate the safety and efficacy of POEM in children with achalasia cardia MethodsThe data of all children (< 18 years) who underwent POEM at our center was retrospectively analysed. Symptoms were analysed using a validated score (Eckardt score) at regular predefined intervals. Objective parameters including high-resolution manometry, timed barium swallow and esophagogastroduodenoscopy were assessed before the procedure and at 1-year follow-up. Clinical success was defined as an Eckardt score ≤ 3. ResultsA total of 15 children underwent POEM during the specified period. Ten out of 15 (10/15) completed 1-year follow-up. Median operative time was 100 (38-240) minutes. Mean pre and post procedure LES pressure were 36.64 ± 11.08 mmHg and 15.65 ± 5.73 mmHg, respectively (P = 0.001). Mean Eckardt score before and after the POEM was 7.32 ± 1.42 and 1.74 ± 0.67, respectively (P = 0.001). Mean percentage improvement in barium emptying at 5 minutes was 63.70 ± 4.46%. All children had complete resolution of symptoms at 1 year. Median weight gain of children at 1 year was 0.65 kg (range, 0.0-4.6). Conclusions

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“…The incidence of achalasia in childhood is 0.11/100000 children annually [1,2] . Overall, less than 5% of patients with symptoms present under the age of 15 [3] . The disease is more prevalent in males and is most commonly idiopathic.…”

Section: Introductionmentioning

confidence: 99%

“…The disease is more prevalent in males and is most commonly idiopathic. Achalasia has been associated with Trisomy 21, congenital hypoventilation syndrome, glucocorticoid insufficiency, eosinophilic esophagitis, familial dysautonomia, Chagas' disease, and achalasia, alacrima, and ACTH insensitivity (AAA) syndrome [3] . Failure of the lower esophageal sphincter to relax leads to the sequelae of achalasia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

114

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Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.

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Diagnosis, misdiagnosis, and associated diseases of achalasia in children and adolescents: a twelve-year single center experience

Abstract: Achalasia symptoms may mimic common diseases in children, and therefore, may delay the diagnosis. This study emphasizes the importance of the clinical symptoms for the diagnosis of achalasia, mainly in those cases with associated disorders.

Cited by 94 publications

References 31 publications

First Identified Case in Literature: Association of Achalasia and Celiac Diseases

First Identified Case in Literature: Association of Achalasia and Celiac Diseases

Per Oral Endoscopic Myotomy in Children with Achalasia Cardia

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

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