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Achalasia cardia in infancy and childhood: an Indian experience

R J Thomas1, S Sen, N Zachariah

  • 1Department of Paediatric Surgery, Christian Medical College & Hospital, Vellore, India.

Journal of the Royal College of Surgeons of Edinburgh
|June 11, 1998
PubMed

Insights

Infantile achalasia presents with respiratory issues and vomiting, often misdiagnosed as GER. Esophagocardiomyotomy surgery proved effective for most infants with this rare esophageal condition.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Neonatology

Background:

  • Achalasia cardia is a rare esophageal motility disorder.
  • Infantile achalasia often presents with atypical symptoms, including respiratory distress and vomiting.
  • Vomiting of uncurdled milk is a key diagnostic indicator in infants.

Purpose of the Study:

  • To describe the clinical presentation and management of achalasia cardia in children, particularly infants.
  • To evaluate the efficacy and safety of esophagocardiomyotomy in this pediatric population.
  • To highlight associated conditions like alacrima and neurogenic bladder.

Main Methods:

  • Retrospective review of seven pediatric cases of achalasia cardia over a 10-year period.
  • Surgical intervention using esophagocardiomyotomy (transthoracic or transabdominal with fundoplication).
  • Clinical assessment of pre- and post-operative symptoms and outcomes.

Main Results:

  • Six of seven patients were infants, with respiratory symptoms predominating.
  • Five out of six surgically treated patients had good outcomes.
  • One post-operative mortality occurred.
  • Two infants presented with associated alacrima, one with a neurogenic bladder.

Conclusions:

  • Esophagocardiomyotomy is an effective treatment for pediatric achalasia cardia.
  • Early diagnosis is crucial, differentiating infantile achalasia from gastroesophageal reflux (GER).
  • Associated conditions like alacrima warrant further investigation in affected infants.

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