Muhammad Naeem Ashraf, Muhammad Shahbaz Bakht Kayani, Muhammad Nazim Khan.
Early Childhood Achalasia Cardia: a local experience.
Pak J Med Health Sci Jan ;8(3):744-6.

Introduction: Achalasia cardia is rare in early childhood, presenting with difficulty in swallowing, regurgitation, choking, apnea, pneumonitis and impaired growth. Diagnosis depends on radiology and manometry. However; Clinical suspicion remains the key to diagnosis. Heller cardiomyotomy is safe and effective treatment. Methods: Ten children with achalasia cardia, four of them infants, were seen over a 6-year period from Jan. 2002 to Dec. 2007. Male to female ratio was 3:2. Two of the affected children also had alacrima. Vomiting, cough, chest infection and failure to thrive were the presenting complaints and diagnosis was confirmed by barium study. All children underwent transabdominal modified heller esophagocardiomyotomy with anterior fundoplication. Results: The most troubling symptom of vomiting settled after surgery and children took feed normally. There was no postoperative mortality and follow up showed excellent results. Conclusion: Achalasia is rare in infancy. In our society, where consanguineous marriages are a tradition, physician should have high index of suspicion in children presenting with recurrent chest infections. The possible association of dry eyes with achalasia should also be considered. The best way to treat this malady is transabdominal modified heller’s cardiomyotomy with anterior fundoplication.

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