Treatment of Idiopathic Achalasia in the Pediatric Population: A Systematic Review

Abstract

Background Achalasia is a rare idiopathic neuromuscular disorder of the esophagus, characterized as a syndrome of impaired relaxation of the lower esophageal sphincter and decreased peristalsis of the esophageal body.

Objective The primary objective is to determine the best first-line treatment for pediatric achalasia based on the consolidation of the current literature that compares outcomes after pneumatic dilatation (PD) versus surgical myotomy (Heller esophagomyotomy [HM]).

Data Sources A systematic review of English articles using OVID was performed.

Study Selection OVID was used to search for articles focusing on the treatment of pediatric esophageal achalasia with PD versus HM.

Data Extraction Independent extraction of data was performed by N.E.S using predefined data fields.

Data Synthesis Seven articles were included in the systematic review. Techniques of HM and PD varied widely. The best first-line treatment of pediatric achalasia was determined to be HM in two articles, PD in one article, and equal efficacy in one article. Three articles concluded that appropriate initial treatment was determined by the age of the child.

Conclusion Adequate comparative data are lacking to determine the ideal treatment of pediatric achalasia. Appropriately designed randomized controlled trials with long-term follow-up are needed to determine ideal treatment algorithms in pediatric achalasia.

Keywords

achalasia - pneumatic dilatation - Heller myotomy

• References

• 1 Liberati A, Altman DG, Tetzlaff J , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62 (10) e1-e34
• 2 Lee CW, Kays DW, Chen MK, Islam S. Outcomes of treatment of childhood achalasia. J Pediatr Surg 2010; 45 (6) 1173-1177
• 3 Zhang Y, Xu CD, Zaouche A, Cai W. Diagnosis and management of esophageal achalasia in children: analysis of 13 cases. World J Pediatr 2009; 5 (1) 56-59
• 4 Pastor AC, Mills J, Marcon MA, Himidan S, Kim PC. A single center 26-year experience with treatment of esophageal achalasia: is there an optimal method?. J Pediatr Surg 2009; 44 (7) 1349-1354
• 5 Berquist WE, Byrne WJ, Ament ME, Fonkalsrud EW, Euler AR. Achalasia: diagnosis, management, and clinical course in 16 children. Pediatrics 1983; 71 (5) 798-805
• 6 Azizkhan RG, Tapper D, Eraklis A. Achalasia in childhood: a 20-year experience. J Pediatr Surg 1980; 15 (4) 452-456
• 7 Nakayama DK, Shorter NA, Boyle JT, Watkins JB, O'Neill Jr JA. Pneumatic dilatation and operative treatment of achalasia in children. J Pediatr Surg 1987; 22 (7) 619-622
• 8 Jung C, Michaud L, Mougenot JF , et al. Treatments for pediatric achalasia: Heller myotomy or pneumatic dilatation?. Gastroenterol Clin Biol 2010; 34 (3) 202-208
• 9 Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 2004; 53 (5) 629-633
• 10 Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology 1992; 103 (6) 1732-1738
• 11 Boeckxstaens GE, Annese V, des Varannes SB , et al; European Achalasia Trial Investigators. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med 2011; 364 (19) 1807-1816