Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Pyun, Jung Eun (Department of Pediatrics, Korea University College of Medicine) ;
  • Choi, Da Min (Department of Pediatrics, Korea University College of Medicine) ;
  • Lee, Jung Hwa (Department of Pediatrics, Korea University College of Medicine) ;
  • Yoo, Kee Hwan (Department of Pediatrics, Korea University College of Medicine) ;
  • Shim, Jung Ok (Department of Pediatrics, Korea University College of Medicine)
  • Received : 2014.08.26
  • Accepted : 2014.09.06
  • Published : 2015.03.30
Download PDF
⟨ Previous Next ⟩

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.

Keywords

References

  1. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900-20. https://doi.org/10.1111/j.1572-0241.2006.00630.x
  2. Lightdale JR, Gremse DA; Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics 2013;131:e1684-95. https://doi.org/10.1542/peds.2013-0421
  3. Rosen R, Nurko S. The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol 2004;99:2452-8. https://doi.org/10.1111/j.1572-0241.2004.40268.x
  4. Shoenut JP, Micflikier AB, Yaffe CS, Den Boer B, Teskey JM. Reflux in untreated achalasia patients. J Clin Gastroenterol 1995;20:6-11. https://doi.org/10.1097/00004836-199501000-00004
  5. Smart HL, Mayberry JF, Atkinson M. Achalasia following gastro-oesophageal reflux. J R Soc Med 1986;79:71-3. https://doi.org/10.1177/014107688607900204
  6. Franklin AL, Petrosyan M, Kane TD. Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management. World J Gastrointest Endosc 2014;6:105-11. https://doi.org/10.4253/wjge.v6.i4.105
  7. Kahrilas PJ, Sifrim D. High-resolution manometry and impedance-pH/manometry: valuable tools in clinical and investigational esophagology. Gastroenterology 2008;135:756-69. https://doi.org/10.1053/j.gastro.2008.05.048
  8. Dellon ES. Eosinophilic esophagitis. Gastroenterol Clin North Am 2013;42:133-53. https://doi.org/10.1016/j.gtc.2012.11.008
  9. Roskies M, Zielinski D, Levesque D, Daniel SJ. Atypical presentations of achalasia in the pediatric population. J Otolaryngol Head Neck Surg 2012;41:E44-6.
  10. Kahrilas PJ, Boeckxstaens G. The spectrum of achalasia: lessons from studies of pathophysiology and high-resolution manometry. Gastroenterology 2013;145:954-65. https://doi.org/10.1053/j.gastro.2013.08.038
  11. Ganatra JV, Bostwick HE, Medow MS, Beneck D, Berezin S. Candida esophagitis in a child with achalasia. J Pediatr Gastroenterol Nutr 1996;22:330-3. https://doi.org/10.1097/00005176-199604000-00020
  12. Cools-Lartigue J, Chang SY, Mckendy K, Mayrand S, Marcus V, Fried GM, et al. Pattern of esophageal eosinophilic infiltration in patients with achalasia and response to Heller myotomy and Dor fundoplication. Dis Esophagus 2013;26:766-75. https://doi.org/10.1111/j.1442-2050.2012.01385.x
  13. Dellon ES. Diagnostics of eosinophilic esophagitis: clinical, endoscopic, and histologic pitfalls. Dig Dis 2014;32:48-53. https://doi.org/10.1159/000357009
  14. Loots CM, Benninga MA, Omari TI. Gastroesophageal reflux in pediatrics; (patho)physiology and new insights in diagnostics and treatment. Minerva Pediatr 2012;64:101-19.
  15. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ; International High Resolution Manometry Working Group. Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil 2012;24(Suppl 1):57-65. https://doi.org/10.1111/j.1365-2982.2011.01834.x

Cited by

  1. Adult and paediatric GERD: diagnosis, phenotypes and avoidance of excess treatments vol.13, pp.9, 2015, https://doi.org/10.1038/nrgastro.2016.109
  2. SLP-Perceived Technical and Patient-Centered Factors Associated with Pharyngeal High-Resolution Manometry vol.34, pp.2, 2019, https://doi.org/10.1007/s00455-018-9954-z