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KMID : 1038820150180010055
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Pediatric Gastroenterology, Hepatology & Nutrition
2015 Volume.18 No. 1 p.55 ~ p.59
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Achalasia Previously Diagnosed as Gastroesophageal Reflux Disease by Relying on Esophageal Impedance-pH Monitoring: Use of High-Resolution Esophageal Manometry in Children
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Pyun Jung-Eun
Choi Da-Min
Lee Jung-Hwa
Yoo Kee-Hwan
Shim Jung-Ok
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Abstract
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Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occursless commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, andnocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percenttime of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Fouryears 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, andhe was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatationprocedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolutionmanometry in children with atypical GERD even after evaluation with an impedance-pH monitor.
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KEYWORD
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Esophageal achalasia, Gastroesophageal reflux, Manometry, Electric impedance, Esophageal pH monitoring, Child
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