Abstract

Classic idiopathic esophageal achalasia (EA) was a rare disease. In the last 30 years, its frequency has increased more than 1000 times. To find out the reason for these changes, 53 articles with EA in children under 18 years were selected from PubMed, including 29 articles with radiological diagnosis EA. Methods. All 29 radiographs were subjected to rentgenometric analysis to determine the true width of the esophagus and the length of the lower esophageal sphincter (LES). This allowed them to be compared with previously published standards and with the radiological characteristics of EA and gastroesophageal reflux disease (GERD). Results. 19 (66%) children had a typical picture of GERD. In 4 (14%) GERD was combined with secondary stenosis, in 3 (10%) cases congenital stenosis of the esophagus and/or LES was diagnosed at surgery and histologically. In one case, based on radiographic analysis, there was a typical picture of EA, and in 2 cases it was impossible to exclude EA. The conclusion of high-resolution manometry (HRM) in 4 patients about the presence of EA contradicted the wide opening of the LES. In 19 of 23 patients with GERD, the muscular layer of the LES and lower part of the esophagus was transected. In 3 cases balloon dilatation was performed. Discussion. Analysis literature indicates that recently have blurred the boundaries of classical EA and GERD. With GERD, complicated by rigid esophagitis and fibrous changes in the LES, there is difficulty in emptying the stomach with dysphagia syndrome. These cases are erroneously identified as true EA and operations are performed as if they were patients with EA. Thus, instead of treating the GERD and preserving the LES, sphincter is cut completely, resulting in a more severe form of GERD. Dissection of the muscular ring in the lower part of the esophagus in most cases leads to the formation of a pseudo-diverticulum, in which refluxant accumulates, causing additional severe damage to the esophagus. Neither high resolution manometry nor pH monitoring contributes to establishing the correct diagnosis. Conclusion. The increase in the incidence of EA is due to the diagnosis of EA syndrome in patients with GERD, and these patients are treated as if they had classic EA, which leads to severe complications.

Keywords

gastroesophageal reflux disease; classical esophageal achalasia; children; high-resolution manometry; x-ray study; syndrome of esophageal achalasia