[Megaoesophagus -- differential diagnosis and therapy (author's transl)].

Functional hindrances in passage of the oesophageal tract are particularly recognised in achalasia, which occurs in less than 5% of children. The megaoesophagus accompanying massive gastro-oesophageal reflux can also be a consequence of functional disturbances. In addition, peptic stenosis of the oesophagus usually causes dilatation of this organ. Other organic stenoses are just as rare, whether they are congenital membranous or fibromuscular stenoses, or occur as secondary narrowing of the oesophagus, following accidental acid-burns. Treatment of choice in achalasia is cardiomyotomy with insertion of a fundus patch. Gastro-oesophageal reflux is usually treated conservatively at first. Operation and fundoplication is indicated only when this treatment is unsuccessful, or primarily in peptic stenosis. In congenital membranous stenosis or acid-burn stenosis, forceful treatment with bougies usually attains the desired ends. On the other hand, congenital fibromuscular narrowing generally requires operative resection.