Cricopharyngeal achalasia in children: surgical and medical treatment.
BACKGROUND
Cricopharyngeal achalasia (CA) is a rare cause of dysphagia in children presenting with non-specific symptoms such as choking, food regurgitation, nasal reflux, coughing, recurrent pneumonia, cyanosis, and failure to thrive. It results from failure of relaxation of the upper esophageal sphincter (UES) and may appea reither as an isolated lesion or in conjunction with other pathologies. Recognition and early diagnosis of this condition may minimize morbidity in children.


OBJECTIVE
To evaluate the clinical course of four children with cricopharyngeal achalasia presenting to our clinic.


METHODS
We conducted a 5 year retrospective chart review in a tertiary referral center.


RESULTS
Four children were diagnosed with primary cricopharyngeal achalasia between 2006 and 2010. Diagnosis was established by videofluoroscopy and all underwent uneventful cricopharyngeal myotomy. Three children recovered completely and one child showed partial improvement. For residual UES spasm in a partially improved patient, botulinum toxin was injected into the UES which led to further improvement. Dysphagia recurred in one child who was successfully treated with botulinum toxin injection.


CONCLUSIONS
Cricopharyngeal myotomy is a safe procedure in infants and young children. Botulinum toxin injection of the UES was found to be effective in refractory cases.
Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel. drendel_michael@yahoo.com
Michael
M
Drendel
Eldar
E
Carmel
Panayiotis
P
Kerimis
Michael
M
Wolf
Yehuda
Y
Finkelstein
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology* / Q000628:therapy; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D049631:Esophageal Sphincter, Upper / Q000187:drug effects / Q000503:physiopathology; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use; D010609:Pharyngeal Muscles / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014741:Video Recording
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A