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Cricopharyngeal Achalasia Presenting as Acute Dysphagia in a Pediatric Patient

Laura Beth O'Neill1, Matthew Magyar1, Brian Reilly2

  • 1Division of Hospital Medicine, Children's National Hospital, Washington, DC, USA.

The Annals of Otology, Rhinology, and Laryngology
|October 7, 2021
PubMed

Insights

Idiopathic cricopharyngeal achalasia (CPA) in a child caused acute dysphagia. Conservative management with supportive care led to symptom resolution and normal swallowing function.

Area of Science:

  • Pediatric Gastroenterology
  • Otolaryngology
  • Pediatric Surgery

Background:

  • Idiopathic cricopharyngeal achalasia (CPA) is a rare condition causing dysphagia in children.
  • Acute onset of dysphagia in pediatric patients necessitates thorough evaluation to rule out foreign bodies and other causes.

Observation:

  • A 16-month-old boy presented with acute gagging, coughing during feeding, and signs of aspiration.
  • Initial investigations including plain films and esophagram suggested an esophageal filling defect, but endoscopy revealed no obstruction.
  • Modified barium swallow (MBS) identified upper esophageal sphincter (UES) dysfunction consistent with CPA.

Findings:

  • The patient received conservative management with nasogastric tube feeding for nutritional support due to aspiration risk.
  • Symptoms gradually resolved over three months post-discharge.
  • A repeat MBS confirmed normal swallowing function and UES function.

Implications:

  • Conservative management with supportive care is effective for acute idiopathic CPA in healthy pediatric patients.
  • This case highlights the importance of a multidisciplinary approach in diagnosing and managing pediatric dysphagia.
  • Early recognition and appropriate supportive care can lead to favorable outcomes in pediatric CPA.
Abstract

Keywords:
achalasiacricopharyngealdysphagiapediatric

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