Esophageal achalasia or gastroesophageal reflux? Pediatric cases analysis
Abstract
Classic idiopathic esophageal achalasia (EA) was a rare disease. In the last 30 years, its frequency has increased more than 1000 times. To find out the reason for these changes, 53 articles with EA in children under 18 years were selected from PubMed, including 29 articles with radiological diagnosis EA. Methods. All 29 radiographs were subjected to rentgenometric analysis to determine the true width of the esophagus and the length of the lower esophageal sphincter (LES). This allowed them to be compared with previously published standards and with the radiological characteristics of EA and gastroesophageal reflux disease (GERD). Results. 19 (66%) children had a typical picture of GERD. In 4 (14%) GERD was combined with secondary stenosis, in 3 (10%) cases congenital stenosis of the esophagus and/or LES was diagnosed at surgery and histologically. In one case, based on radiographic analysis, there was a typical picture of EA, and in 2 cases it was impossible to exclude EA. The conclusion of high-resolution manometry (HRM) in 4 patients about the presence of EA contradicted the wide opening of the LES. In 19 of 23 patients with GERD, the muscular layer of the LES and lower part of the esophagus was transected. In 3 cases balloon dilatation was performed. Discussion. Analysis literature indicates that recently have blurred the boundaries of classical EA and GERD. With GERD, complicated by rigid esophagitis and fibrous changes in the LES, there is difficulty in emptying the…
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