Kumar Nitin, Gadgade Bahubali Deepak, Shivapur Achyuth Ananth, Radhakrishna Veerabhadra, Vasudev Raghunath Bangalore
Department of Pediatric Surgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
J Indian Assoc Pediatr Surg. 2023 Sep-Oct;28(5):369-374. doi: 10.4103/jiaps.jiaps_175_22. Epub 2023 Apr 25.
Achalasia cardia is a neuromuscular disorder of unknown etiology characterized by aperistalsis of the body of the esophagus and failure of relaxation of the lower esophageal sphincter. The diagnosis of achalasia cardia is delayed due to the rarity and the ability to mimic other common conditions in children. Hence, a study was conducted to evaluate the clinical presentation and the management of achalasia cardia in children.
A retrospective observational study was conducted in the department of pediatric surgery at a tertiary center. The children with achalasia cardia who presented between January 2014 and December 2021 were included.
A total of 12 patients were treated for achalasia cardia during the study period. All children presented with recurrent episodes of vomiting, whereas dysphagia was seen in six (50%) children. Eighty-three percent of the children presented with a history of weight loss, whereas failure to thrive was seen in nine (75%) children. Five (42%) children were managed as gastroesophageal reflux disease (GERD) for more than a year before presenting to us. Three (25%) children underwent open cardiomyotomy with Thal fundoplication and the rest nine (75%) underwent laparoscopic cardiomyotomy. All are thriving well.
Achalasia is an important differential diagnosis in children with suspected GERD. The most common symptom of achalasia cardia is vomiting followed by dysphagia. Weight loss and failure to thrive are important presenting features in children with achalasia which are uncommon in adults. Cardiomyotomy without fundoplication is safe and effective to treat achalasia cardia in children without having any extra complications.
贲门失弛缓症是一种病因不明的神经肌肉疾病，其特征为食管体部无蠕动以及食管下括约肌松弛障碍。由于贲门失弛缓症在儿童中较为罕见且有能力模仿其他常见病症，其诊断往往被延迟。因此，开展了一项研究以评估儿童贲门失弛缓症的临床表现及治疗方法。
在一家三级中心的小儿外科进行了一项回顾性观察研究。纳入了2014年1月至2021年12月期间就诊的贲门失弛缓症患儿。
在研究期间，共有12例患儿接受了贲门失弛缓症的治疗。所有患儿均有反复呕吐发作，而6例（50%）患儿出现吞咽困难。83%的患儿有体重减轻史，9例（75%）患儿有生长发育迟缓。5例（42%）患儿在前来就诊前被误诊为胃食管反流病（GERD）超过一年。3例（25%）患儿接受了开放性贲门肌切开术加Thal胃底折叠术，其余9例（75%）患儿接受了腹腔镜贲门肌切开术。所有患儿目前生长发育良好。
贲门失弛缓症是疑似GERD患儿的重要鉴别诊断。贲门失弛缓症最常见的症状是呕吐，其次是吞咽困难。体重减轻和生长发育迟缓是贲门失弛缓症患儿重要的临床表现，在成人中并不常见。不进行胃底折叠术的贲门肌切开术对于治疗儿童贲门失弛缓症是安全有效的，且不会产生任何额外并发症。
