Achalasia of the oesophagus in infancy: a case report

Abstract

Achalasia characteristically causes dismotility of the lower oesophageal sphincter and defective peristalsis of the body of the oesophagus, in response to the act of swallowing, as a result of ganglionic cells degeneration. The resultant oesophageal dilatation leads to food stasis and may cause oesophagitis and tracheobronchial aspiration. Achalasia is a rare occurrence in the paediatric age group and even more extremely rare in the neonate and young infant. Urgent radiologic evaluation of the underlying cause of persistent on-going vomiting in an infant is mandatory. To emphasize the role of upper gastrointestinal imaging in infants with persistent on-going vomiting, severe dehydration and malnutrition through case illustration of a 9-month-old infant seen in a private medical outfit in Lagos. Dilute barium oesophagogram, pre- and postoperatively, was performed in a 9-month-old infant and illustrative images were presented. Literature materials on achalasia of the oesophagus were reviewed and juxtaposed with findings in the illustrated case for discussion. Only 3 to 4 percent of achalasia is reported to occur in the paediatric age group with average duration of 28 months from onset of symptoms to diagnosis. Persistent vomiting and failure to thrive are common. Pneumatic dilatations and surgical myotomy are recommended treatment methods. Urgent upper gastrointestinal contrast study is appropriate in infants with suspected achalasia for successful management.