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Childhood achalasia in Zaria, Nigeria
L B Chirdan1, E A Ameh, P T Nmadu
1Department of Surgery, Paediatric Surgery Unit, Ahmadu Bello University Hospital, Zaria, Nigeria.
Insights
Achalasia of the oesophagus in children often presents with recurrent pneumonia. Modified Heller's myotomy is an effective surgical treatment for pediatric achalasia, leading to symptom resolution.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Disorders
Background:
- Achalasia of the oesophagus is a rare esophageal motility disorder.
- In children, symptoms can be non-specific, leading to delayed diagnosis.
- Recurrent respiratory infections are an important, often overlooked, presenting symptom.
Purpose of the Study:
- To investigate the clinical presentation, management strategies, and outcomes of achalasia in pediatric patients.
- To highlight the importance of considering achalasia in children with recurrent chest infections.
Main Methods:
- Retrospective case study conducted at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
- Analysis of seven pediatric patients diagnosed with achalasia over a 19-year period.
- Diagnosis confirmed via barium esophagogram.
Main Results:
- The study included six boys and one girl, with a median age of 10 years.
- Common symptoms included dysphagia, vomiting, and regurgitation; three patients had prior pneumonia diagnoses.
- Six patients underwent modified Heller's myotomy with a Thal fundoplication, and one had a transthoracic Heller's myotomy. Six achieved complete symptom resolution.
Conclusions:
- Achalasia should be considered in the differential diagnosis of pediatric recurrent chest infections.
- Modified Heller's myotomy performed via the abdominal route, without an antireflux procedure, is an effective treatment for pediatric achalasia.
Objectives:
To study the presentation, management and outcome of achalasia of the oesophagus in children.
Design:
A retrospective case study.
Setting:
Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Subjects:
Seven children managed for achalasia of the oesophagus in a period of 19 years.
Results:
There were six boys and one girl. The median age at presentation was ten years (range three months to fifteen years). The median duration of symptoms before presentation was 20 months (range: 2-24 months). Three children were treated on several occasions for pneumonia before the diagnosis was made. Dysphagia, vomiting and regurgitation were the main presenting symptoms. Diagnosis was by barium oesophagogram. Six had modified Heller's myotomy via celiotomy and a Thal fundoplication in a three month old. Transthoracic Heller's myotomy was done in the seventh child. There was complete resolution of symptoms in six children. One patient had post-operative retrosternal pain, which was controlled by oral nifedipine.
Conclusion:
Achalasia of the oesophagus should be excluded in children with recurrent chest infection. Modified Heller's myotomy without antireflux procedure via the abdominal route is effective in relieving symptoms of achalasia in children.