ACHALASIA

 lack of relaxation of the LES

a
with swallowing

 A relative obstruction at the

level of the sphincter is made
worse by a lack of peristaltic
waves in the esophagus

 the condition affects primarily

adolescents and adults

 children under the age 4 yr

comprise fewer than 5% patients
Clinical M an ifestat ions

 difficulty in swallowing

 regurgitation of food

 cough from overflow of fluids

into the trachea

 failure to gain weight

Diagnosis
 roentgenogram and is
confirmed with manometry
Treatm ent
Dilating the cardio esophageal
junction with a mercury bougie
 Transient relief of symptoms
Treatm ent
Heller procedure
 surgical division of muscles at
the cardioesophageal junction

 permanent relief of symptoms

GAS TR OES OPHAG EAL
RE FLUX ( CH AL AS IA )
 The term chalasia describes
the free reflux across a dilated
sphincter

 When the LES is not competent,

excessive and passive reflux of
gastric contents may cause
significant symptoms
Etiology

 reflux may occur with

increased intra abdominal
pressure

 The small reservoir capacity of

the infant’s esophagus
predisposes to vomiting

 Placement of the gastrostomy

tube encourages reflux

 Mehtylxantines may
exacerbate reflux by lowering
sphincter tone
Clinical M an ifestat ions
signs and symptoms relate
directly to the exposure of the
esophageal epithelium to refluxed
gastric contents
 In 85% of affected infants
excessive vomiting occurs during
the 1st week of life
 an additional 10% have
symptoms by 6wk
 Patients with cerebral palsy,
Down syndrome and other causes
of developmental delay have an
increase incidence of reflux
Clinical M an ifestat ions

 delayed gastric emptying

 forceful vomiting

 aspiration pneumonia

 chronic cough wheezing, clubbing

and recurrent pneumonia

 failure to grow and gain weight



hemorrhage and/or hematemesis
anorexia
Diag nosis
 In mild cases, a careful
clinical assessment may be
sufficient for diagnosis

 barium esophagography
under fluoroscopic control
Diag nosis
 esophagoscopy with biopsy
Treatm ent
In mil d un compli cated
cas es

 keeping the child prone with

head elevated at 20-30 degrees

 thickening the feeding with

cereal

 careful attention to burping

Treatm ent
In sev er e cas es

 antacids or cimetidine given four

times a day (20-40 mg/kg/24 hr )

 metoclopramide (0.5 mg/kg/dose)

4 times a day

 cisapride, 0.2mg/kg qid

 If symptoms do not respond to a

6wk trial of intensive medical
therapy, operative treatment may
be indicated
Treatm ent
 Bougienage of strictures can provide
temporary relief of dysphagia

 Nissen fundoplication
Tre at ment
Tre at ment
 occasionally, stricture
formation is so extensive that
colonic interposition is required
to replace a portion of the
esophagus
Thank You!
jgyif
Your Topic Goes Here
Your subtopic goes here
 www.animationfactory.com

Backdrops: Title Backdrop Slide Backdrop Print Backdrop Transitional Backdrop

- These are full sized

backdrops, just scale them up!
- Can be Copy-Pasted out of
Templates for use anywhere!

Additional Graphics:
- Scale them up or down!
- .GIF clipart is animated.
- .JPG clipart can be scaled
up and take up little file
space.
- .PNG clipart can be scaled
unusually large without
distortion.