Advances in The Diagnosis and Treatment of Achalasia of The Cardia: a Review

Infantile achalasia cardia: A rare case report of a 3-month-old female with recurrent pneumonia successfully treated with surgical intervention

INTRODUCTION

Achalasia, a rare esophageal disorder with an annual incidence of 0.11 per 100,000 in children, is characterized by impaired lower esophageal sphincter (LES) relaxation and peristalsis. Infantile cases are extremely uncommon and often linked to genetic conditions like Allgrove and Down syndrome. Diagnosis is challenging due to overlapping symptoms with other pediatric conditions, relying on barium esophagography and esophageal manometry. Heller myotomy remains the preferred surgical treatment to reduce LES pressure.

CASE PRESENTATION

A 3-month-old female presented with a history of cough, feeding difficulties, and regurgitation, accompanied by respiratory distress and recurrent pneumonia. She was diagnosed with achalasia cardia based on clinical findings and contrast-enhanced esophagography. A modified Heller myotomy with Dor-fundoplication was performed successfully, with no postoperative complications. The patient was discharged in stable condition.

DISCUSSION

Infantile achalasia, a rare condition with unclear etiology, often presents diagnostic challenges. Our early-onset case, lacking syndromic associations, was complicated by recurrent pneumonia, necessitating surgical intervention. The successful outcome after a modified Heller myotomy with Dor-fundoplication supports its efficacy in severe pediatric cases, though long-term monitoring for recurrence is essential.

CONCLUSION

Achalasia cardia, though rare in infants, should be considered as differential in cases of recurrent pneumonia and feeding difficulties, as its presentation often mimics more common conditions. Prompt diagnosis through thorough evaluation and imaging is essential to ensure timely treatment and improve outcomes.

Development and status quo of digestive endoscopy in China: An analysis based on the national census in 2013 and 2020

Background and Objectives

Technique and practice of digestive endoscopy are undergoing speedy development all over the world. This study aimed to evaluate its status quo and development in China.

Methods

All hospitals performing digestive endoscopy in mainland China participated in the national census in 2013 and 2020. Retrospective data of hospitals, endoscopists, volumes, and qualities were collected via an online structured questionnaire, and its accuracy and rationality were verified by logical tests and manual reviews. Data from other countries were used to compare with that of China.

Results

From 2012 to 2019, the number of hospitals performing digestive endoscopy increased from 6,128 to 7,470 (1.22-fold), in which primary healthcare played a minor role. The median hospitals per 100,000 inhabitants per provincial region increased from 0.49 (IQR, 0.39-0.57) to 0.55 (IQR, 0.49-0.63). The endoscopists increased from 26,203 to 39,638 (1.51-fold), but their average workload even expanded. Overall volume increased from 28.8 million to 44.5 million (1.55-fold), and most types of endoscopic procedures recorded a high growth rate. Contrastingly, the specific utilization rates were low and paled in comparison with some developed countries. Nationwide, regional utilization rates showed a significant correlation with GDP per capita (P <0.001). Overall qualities of digestive endoscopy were excellent, but certain results of quality indicators posed a huge challenge, such as the detection rates of adenoma and early cancers.

Conclusions

Impressive progress has been made in digestive endoscopy with rapidly expanding economy in China. However, primary healthcare, utilization rates, and income-related inequality of regional services were needed to be improved to promote public health better.

A rare case of mega-esophagus due to achalasia causing tracheal compression

Achalasia is one of the most common esophageal motility disorders. Typical symptoms include dysphagia, food regurgitation, respiratory symptoms, chest pain, and weight loss. Respiratory obstruction due to tracheal compression by the massively dilated esophagus is a very rare but fatal complication. A 36-year-old male presented with progressive respiratory distress with a history of untreated dysphagia and regurgitation. Further diagnosis revealed dilatation of the esophagus with undigested food. A Heller myotomy with fundoplication was performed and respiratory symptoms were relieved. Tracheal compression and acute airway obstruction caused by esophageal dilatation in achalasia is a rare presentation. Early recognition of this rare manifestation is critical and emergency treatment is necessary for life saving. Radiological examination can help physicians find the dilated esophagus. Respiratory symptoms resulting from tracheal compression by a dilated esophagus rarely occurred. Even though physicians should be alert and early decompression has to be performed immediately.