Achalasia of the cardia: experience with hydrostatic balloon dilatation in children.

BACKGROUND

Achalasia is a disorder of oesophageal motility and is rare in children. The mainstay of therapy has been surgery with its attendant complications and long postoperative stay. Treatment by hydrostatic balloon dilatation, a less morbid procedure, has not found much favour.

OBJECTIVE

To review the overall efficacy of balloon dilatation for the treatment of achalasia in children and to highlight the high incidence of non-syndromic familial cases in Oman.

MATERIALS AND

METHODS

This is a retrospective study of all patients ( n=12) with achalasia treated with balloon dilatation at the Royal Hospital, Muscat, from 1991 to 1999. The diagnosis was established with a barium oesophagogram. Dilatation was performed under general anaesthesia. On follow-up, the weight and recurrence of symptoms were recorded. Investigations were done only if the patients were symptomatic on follow-up. Recurrence was treated with further dilatation.

RESULTS

Of the 12 patients, 10 had excellent alleviation of symptoms. Two patients developed recurrence of symptoms which responded favourably to further dilatation. The average length of postoperative stay in the hospital was 2 days. Of these 12 patients, there were 3 sets of siblings who did not have any other syndromic associations. This group also showed very good prognosis. The mean follow-up period was 3.5 years for all patients.

CONCLUSIONS

The results of balloon dilatation were very satisfactory. We also recommend this procedure when there is recurrence of symptoms. It has lower morbidity than surgery and hospital stay is shorter. Furthermore, we have a high rate of non-syndromic familial cases, all with a favourable outcome.