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

Abstract

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.

Laparoscopic Heller–Dor Is a Persistently Effective Treatment for Achalasia Even in Pediatric Patients: A 25-Year Experience at a Single Tertiary Center

“…19 Complicating furthermore, gastrointestinal symptoms can also be associated with nocturnal cough or respiratory infections, mainly due to food aspiration or airway compression. 20 An association with autism has also been described, and a correlation with esophageal atresia can be found in episodic communications. 21,22 Published studies on the treatment of achalasia in children often present multiple limitations, including: small patient cohorts; incomplete preoperative assessment; patients with a history of multiple attempts at medical or endoscopic treatment prior to myotomy; no clear definition of postoperative success or failure; and no long-term followup.…”

Tissue‐engineered tracheal implants: Advancements, challenges, and clinical considerations

“…Trauma-induced tracheal lesions 2.5%-3.2% of fatalities in trauma cases 0.5%-2.0% of individuals with chest or neck injuries due to trauma <1% of planned orotracheal intubations 0.05%-0.37% of instances involving endotracheal intubations [6][7][8][9][10][11] Tracheal malignancies <1% of the population <1% of individuals each year [12,13] Aplasia of trachea <1% in neonates [14] TBM 23% of COPD patients 44% of individuals with chronic bronchitis 1% of the total patients undergoing bronchoscopy [1] Intubation-related tracheal stenosis 6%-21% following intubation [15] Congenital esophageal obstruction <1% in neonates [16,17] Tracheoesophageal fistulas <1% in neonates [18] pediatric population, congenital anomalies, such as birth abnormalities, esophageal atresia, and tracheoesophageal fistulas, present distinct challenges, with tracheal agenesis occurring as a less common anomaly, impacting less than 1/50,000 infants. 14,[16][17][18] While tracheal stenosis in adults is typically addressed through resection and anastomosis, this approach is less feasible in infants and children, especially when the lesion involves exceeding 50% of the total trachea length. 2 Attempts to provide support using various stents, comprising biodegradable alternatives and Palmaz stents, have achieved limited success.…”

“…Post‐intubation airway stenosis occurs in approximately 5%–20% of intubated cases, and recent evidence suggests a potential rise in tracheal stenosis cases among patients recovering from coronavirus disease 2019 who required mechanical ventilation 15 . In the pediatric population, congenital anomalies, such as birth abnormalities, esophageal atresia, and tracheoesophageal fistulas, present distinct challenges, with tracheal agenesis occurring as a less common anomaly, impacting less than 1/50,000 infants 14,16–18 …”

“…Tracheal afflictions in adults encompass a spectrum of etiologies, predominantly stemming from traumatic injuries, benign conditions (notably tracheobronchomalacia, TBM), and various cancer types (Table 1 ). 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 Although precise incidence figures are challenging to ascertain, tracheobronchial injuries contribute to 2.5%–3.2% of trauma‐related fatalities and affect 0.6%–2.1% of trauma cases admitted complicated with neck or pulmonary injuries. 6 , 7 , 8 , 9 , 10 , 11 Malignant tumors invading the trachea often necessitate lesion resection and one‐stage structure reconstruction, encompassing primary Tracheal or bronchus malignancies such as adenoid cystic carcinoma and squamous cell carcinoma.…”

Interpretation of Impedance Data on High-resolution Impedance Manometry Studies—A Worldwide Survey

“…Dysphagia is a clinical manifestation of several disorders, and can have a major impact on quality of life of adult and pediatric populations. 1 , 2 Evaluation and management of dysphagia dramatically changed with the introduction of esophageal manometry. 3 Manometry studies use measurement of contraction pressures generated throughout the esophageal body during standardized swallow challenge and are considered the gold standard for the evaluation of esophageal motility patterns and disorders.…”