Pediatr Gastroenterol Hepatol Nutr.  2015 Mar;18(1):55-59. 10.5223/pghn.2015.18.1.55.

Achalasia Previously Diagnosed as Gastroesophageal Reflux Disease by Relying on Esophageal Impedance-pH Monitoring: Use of High-Resolution Esophageal Manometry in Children

• Pyun JE
• Choi DM
• Lee JH
• Yoo KH
• Shim JO

• KMID: 2315536
• DOI: http://doi.org/10.5223/pghn.2015.18.1.55

Abstract

Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.

Keyword

Esophageal achalasia; Gastroesophageal reflux; Manometry; Electric impedance; Esophageal pH monitoring; Child

MeSH Terms

Candidiasis
Child*
Cough
Deglutition Disorders
Dilatation
Electric Impedance
Endoscopy
Esophageal Achalasia*
Esophageal pH Monitoring
Esophagus
Failure to Thrive
Gastroesophageal Reflux*
Heartburn
Humans
Lost to Follow-Up
Male
Manometry*
Vomiting

Figure

• 

  Fig. 1 Esophageal endoscopy of the upper and mid-esophagus revealed a dilated esophageal body and multiple whitish plaques caused by achalasia and candidiasis.

• 

  Fig. 2 High-resolution manometry revealed type I achalasia. Mean integrated relaxation pressure was 23.9 mmHg and aperistalsis was demonstrated.

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  Fig. 3 Pneumatic dilatation for the treatment of esophageal achalasia in a child. (A) First endoscopic pneumatic dilatation with a 18-mm diameter balloon. (B) Fluoroscopic image showing second pneumatic dilatation with a 24-mm diameter balloon.

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