title: Achalasia Previously Diagnosed as Gastroesophageal Reflux Disease by Relying on Esophageal Impedance-pH Monitoring: Use of High-Resolution Esophageal Manometry in Children.
abstract: Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.
authors: Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
authors: Jung Eun
authors: JE
authors: Pyun
authors: Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
authors: Da Min
authors: DM
authors: Choi
authors: Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
authors: Jung Hwa
authors: JH
authors: Lee
authors: Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
authors: Kee Hwan
authors: KH
authors: Yoo
authors: Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
authors: Jung Ok
authors: JO
authors: Shim
keywords: Child; Electric impedance; Esophageal achalasia; Esophageal pH monitoring; Gastroesophageal reflux; Manometry