Late diagnosis of idiopathic esophageal achalasia in patient with recurrent pneumonias

Abstract

Esophageal achalasia is the most prevalent esophageal motility disease; however, it is rare in pediatrics. The principal cause is secondary to the loss of function in inhibitory neurons of myenteric plexus, due inflammatory process of unknown origin. The most prevalent symptoms in children are vomit, loss of weight and aspiration pneumonia; those are more commonly related to gastroesophageal reflux disease (GERD), making it more difficult the diagnosis of achalasia. Complementary exams are crucial to diagnoses, such as upper digestive endoscopy, radiography (barium swallow) and esophageal manometry. The treatment aims to relieve the symptoms and improve the esophageal emptying. Three years old female child, presenting persistent vomit, pulmonary auscultation reduced at right lung and condensation in the right pulmonary base suggestive of pneumonia, regarding an antecedent of five episodes of pneumonia. The symptoms started at nine months old, and the initial treatment was for GERD, without improvement. The propaedeutic confirmed the diagnoses of achalasia, though etiology was not conclusive. The chosen treatment was pneumatic dilatation with an additional surgical injection of botulinum toxin at the lower esophageal sphincter. The patient received hospital discharge to outpatient follow-up.