New diagnostic and therapeutic procedures applied in pediatric esophageal achalasia in a pediatric tertiary center: A case series

Pop,Daniela; Pop,Radu Samuel; Blaga,Teodora Surdea; David,Liliana; Asavoaie,Carmen; Tantau,Marcel; Dumitrascu,Dan Lucian; Farcau,Dorin

doi:10.3892/etm.2023.11800

New diagnostic and therapeutic procedures applied in pediatric esophageal achalasia in a pediatric tertiary center: A case series

Authors:
- Daniela Pop
- Radu Samuel Pop
- Teodora Surdea Blaga
- Liliana David
- Carmen Asavoaie
- Marcel Tantau
- Dan Lucian Dumitrascu
- Dorin Farcau
View Affiliations

Affiliations: Third Pediatric Discipline, Mother and Child Department, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400394 Cluj‑Napoca, Romania, Second Medical Department, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400000 Cluj‑Napoca, Romania, Gastroenterology Department, Second Medical Clinic, Emergency Clinical County Hospital, 400000 Cluj‑Napoca, Romania, Department of Radiology, Clinical Emergency Hospital for Children, 400394 Cluj‑Napoca, Romania, Third Medical Department, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400162 Cluj‑Napoca, Romania, Third Pediatric Department, Clinical Emergency Hospital for Children, 400394 Cluj‑Napoca, Romania
Published online on: January 17, 2023 https://doi.org/10.3892/etm.2023.11800
Article Number: 101
Copyright: © Pop et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Achalasia is an esophageal motor disorder that is rare in children. While the condition is uncommon, it is especially difficult to diagnose in pediatric patients; however, the ability to form a diagnosis has progressed markedly with the advent of esophageal high‑resolution manometry (HRM). The aim of the present study was to highlight particularities of the diagnosis, based on esophageal HRM, as well as the treatment of achalasia in children. The current study analyzed cases of achalasia from a single pediatric tertiary center, Clinical Emergency Hospital for Children (Cluj‑Napoca, Romania). The clinical data and the results of the investigations of seven children with achalasia, the first children to be evaluated using esophageal HRM in the center, were reported. The patients were aged between 11 and 18 years. All the patients were newly diagnosed with achalasia, except for one. The duration of symptoms was between 4 months and 2 years in the newly diagnosed patients. All the patients were assessed with conventional esophageal manometry and/or esophageal HRM. A multidisciplinary team contributed to the diagnosis and the management of achalasia. A total of 4 children diagnosed with type II achalasia were treated with peroral endoscopic myotomy (POEM) and 3 of the patients were treated with pneumatic dilations. Overall, achalasia is a rare but challenging condition in children. A diagnosis starts with a clinical suspicion based on swallowing disorders and upper digestive endoscopy, and is confirmed by esophageal HRM. Therapy should be adapted to the type of achalasia, the age of the children and the severity. In the present study, a relatively recent treatment option, POEM, was applied in pediatric patients with minor immediate adverse events. The report of these cases adds to the limited experience of using HRM and POEM in children with achalasia.

View Figures

View References

1	Furuzawa-Carballeda J, Aguilar-León D, Gamboa-Domínguez A, Valdovinos MA, Nuñez-Álvarez C, Martín-del-Campo LA, Enríquez AB, Coss-Adame E, Svarch AE, Flores-Nájera A, et al: Achalasia-An autoimmune inflammatory disease: A cross-sectional Study. J Immunol Res. 2015(729217)2015.PubMed/NCBI View Article : Google Scholar
2	van Lennep M, van Wijk MP, Omari TIM, Benninga MA and Singendonk MMJ: Clinical management of pediatric achalasia. Expert Rev Gastroenterol Hepatol. 12:391–404. 2018.PubMed/NCBI View Article : Google Scholar
3	Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ and Pandolfino JE: International High Resolution Manometry Working Group. The chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 27:160–174. 2015.PubMed/NCBI View Article : Google Scholar
4	van Lennep M, van Wijk MP, Omari TIM, Salvatore S, Benninga MA and Singendonk MMJ: European Society for Paediatric Gastroenterology, Hepatology and Nutrition Motility Working Group. Clinical management of pediatric achalasia: A survey of current practice. J Pediatr Gastroenterol Nutr. 68:521–526. 2019.PubMed/NCBI View Article : Google Scholar
5	Eckardt VF, Aignherr C and Bernhard G: Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 103:1732–1738. 1992.PubMed/NCBI View Article : Google Scholar
6	Moosmann J, Krusemark A, Dittrich S, Ammer T, Rauh M, Woelfle J, Metzler M and Zierk J: Age- and sex-specific pediatric reference intervals for neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio. Int J Lab Hematol. 44:296–301. 2022.PubMed/NCBI View Article : Google Scholar
7	Singendonk MM, Smits MJ, Heijting IE, van Wijk MP, Nurko S, Rosen R, Weijenborg PW, Abu-Assi R, Hoekman DR, Kuizenga-Wessel S, et al: Inter- and intrarater reliability of the Chicago Classification in pediatric high-resolution esophageal manometry recordings. Neurogastroenterol Motil. 27:269–276. 2015.PubMed/NCBI View Article : Google Scholar
8	Patel DA, Naik R, Slaughter JC, Higginbotham T, Silver H and Vaezi MF: Weight loss in achalasia is determined by its phenotype. Dis Esophagus. 31:1–8. 2018.PubMed/NCBI View Article : Google Scholar
9	Nurko S: Motility Disorders in Children. Pediatr Clin North Am. 64:593–612. 2017.PubMed/NCBI View Article : Google Scholar
10	Nurko S: The Esophagus: motor disorders. In: Pediatric Gastrointestinal disease. Walker WA (ed). B.C. Decker Inc, Philadelphia, PA, pp317-350, 2000.
11	Romero-Hernández F, Furuzawa-Carballeda J, Hernández-Molina G, Alejandro-Medrano E, Núñez-Álvarez CA, Hernández-Ramírez DF, Azamar-Llamas D, Olivares-Martínez E, Breña B, Palacios A, et al: Autoimmune comorbidity in achalasia patients. J Gastroenterol Hepatol. 33:203–208. 2018.PubMed/NCBI View Article : Google Scholar
12	López-Verdugo F, Furuzawa-Carballeda J, Romero-Hernández F, Coss-Adame E, Valdovinos MA, Priego-Ranero A, Olvera-Prado H, Narváez-Chavez S, Peralta-Figueroa J and Torres-Villalobos G: Hematological indices as indicators of silent inflammation in achalasia patients: A cross-sectional study. Medicine (Baltimore). 99(e19326)2020.PubMed/NCBI View Article : Google Scholar
13	Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB and Kavitt RT: ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol. 115:1393–1411. 2020.PubMed/NCBI View Article : Google Scholar
14	Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H and Kudo S: Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 42:265–271. 2010.PubMed/NCBI View Article : Google Scholar
15	Lee Y, Brar K, Doumouras AG and Hong D: Peroral endoscopic myotomy (POEM) for the treatment of pediatric achalasia: A systematic review and meta-analysis. Surg Endosc. 33:1710–1720. 2019.PubMed/NCBI View Article : Google Scholar
16	Zhong C, Tan S, Huang S, Peng Y, Lü M and Tang X: Clinical outcomes of peroral endoscopic myotomy for achalasia in children: A systematic review and meta-analysis. Surg Endosc. 34(doaa112)2021.PubMed/NCBI View Article : Google Scholar
17	Inoue H, Ueno A, Shimamura Y, Manolakis A, Sharma A, Kono S, Nishimoto M, Sumi K, Ikeda H, Goda K, et al: Peroral endoscopic myotomy and fundoplication: A novel NOTES procedure. Endoscopy. 51:161–164. 2019.PubMed/NCBI View Article : Google Scholar
18	Oude Nijhuis RAB. Zaninotto G, Roman S, Boeckxstaens GE, Fockens P, Langendam MW, Plumb AA, Smout A, Targarona EM, Trukhmanov AS, et al: European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations. United European Gastroenterol J. 8:13–33. 2020.PubMed/NCBI View Article : Google Scholar
19	Nabi Z, Ramchandani M, Basha J, Goud R, Darisetty S and Reddy DN: POEM is a durable treatment in children and adolescents with Achalasia Cardia. Front Pediatr. 10(812201)2022.PubMed/NCBI View Article : Google Scholar
20	Sharp NE and St Peter SD: Treatment of idiopathic achalasia in the pediatric population: A systematic review. Eur J Pediatr Surg. 26:143–149. 2016.PubMed/NCBI View Article : Google Scholar
21	Goneidy A, Cory-Wright J, Zhu L and Malakounides G: Surgical management of esophageal achalasia in pediatrics: A systematic review. Eur J Pediatr Surg. 30:13–20. 2020.PubMed/NCBI View Article : Google Scholar
22	Miao S, Wu J, Lu J, Wang Y, Tang Z, Zhou Y, Huang Z, Ying H and Zhou P: Peroral endoscopic myotomy in children with achalasia: A relatively long-term single-center study. J Pediatr Gastroenterol Nutr. 66:257–262. 2018.PubMed/NCBI View Article : Google Scholar
23	Tashiro J, Petrosyan M and Kane TD: Current management of pediatric achalasia. Transl Gastroenterol Hepatol. 6(33)2021.PubMed/NCBI View Article : Google Scholar
24	Mencin AA, Sethi A, Barakat MT and Lerner DG: Peroral endoscopic myotomy (POEM) in children: A state of the art review. J Pediatr Gastroenterol Nutr. 75:231–236. 2022.PubMed/NCBI View Article : Google Scholar
25	Choné A, Familiari P, von Rahden B, Desai P, Inoue H, Shimamura Y, Eleftheriadis N, Yamashita K, Khashab MA, Shiwaku H, et al: Multicenter evaluation of clinical efficacy and safety of per-oral endoscopic myotomy in children. J Pediatr Gastroenterol Nutr. 69:523–552. 2019.PubMed/NCBI View Article : Google Scholar
26	Tefas C, Boroș C, Ciobanu L, Surdea-Blaga T, Tanțău A and Tanțău M: POEM: Five years of experience in a single East European Center. J Gastrointestin Liver Dis. 29:323–328. 2020.PubMed/NCBI View Article : Google Scholar