Achalasia in children
The possibility of determining the pressure in the esophagus( esophagometry) has revealed a weak tonic stress of the lower esophageal sphincter in newborns. Gradually, by the end of the first - the beginning of the second month of the child's life, the magnitude of this tonic tension increases, sometimes reaching the level of the adult. Insufficient increase in the tone of the lower esophageal sphincter at normal times( 1-2 months), too slow increase in the pressure gradient in the esophagus and stomach leads to the formation of a constant, prolonged time of persisting regurgitation in young children. In such cases, talk about acquired achalasia or insufficient cardia.
The manifestations of achalasia( calasia- relaxation) are aggravated by such diseases of the digestive system as gastritis, gastroduodenitis, peptic ulcer of the stomach and duodenum. Often, achalasia is combined with a hernia of the esophageal opening of the diaphragm. All diseases accompanied by increased intra-abdominal pressure, for example, tumors of the abdominal cavity, contribute to the occurrence of achalasia.
Severe regurgitation and vomiting are the main symptoms of achalasia, they appear shortly after birth. Often observed belching and regurgitation. The intensity of these symptoms depends on the position of the patient's body: lying they are sharply expressed and weaken when moving to the vertical position. Prolonged achalasia eventually leads to an esophagitis with symptoms characteristic of this disease( dysphagia, heartburn, pain sensations).
Regurgitation and vomiting lead to the fact that a child with achalasia due to partial fasting is poorly added to body weight, anemia develops. Less often, dehydration occurs. Some authors point out the possibility of aspiration pneumonia.
Endoscopic and X-ray methods of investigation, as well as intra-esophageal and intragastric pH-metry, radiotelemetry, and esophagotho-kymography are decisive in the final diagnosis of achalasia. Esophagofibroscopy reveals the casting of gastric contents into the esophagus, often the inconsistency of the cardia, as well as the symptoms of reflux esophagitis.
When X-ray examination in the position of the patient lying, an inverse current of the barium suspension from the stomach into the esophagus is detected, which is especially noticeable during inspiration. The pellet suspension into the esophagus is strengthened by pressing on the stomach area, and in older children - when straining. Both indicated methods increase intra-abdominal pressure.
With the help of the pH-meter, the "acidification" of the medium in the region of the cardinal part of the esophagus is revealed as a result of the casting of acidic gastric contents. Ezofagometometry always determines the reduced tone of the cardia. These same pathological phenomena are diagnosed by the radiotelemetric method.
Achalasia should be differentiated from esophageal stenosis, pilorospasm and pyloric stenosis, hernia of the esophageal opening of the diaphragm.
In young children, treatment begins with the ordering of the feeding. The number of meals increases, but for every reception the volume of food decreases. In addition to breast milk, other foods( mixtures) are prescribed to the child with a more dense consistency. Feeding is carried out in the vertical position of the child, which he should take for another 2-3 hours after eating. In severe cases of achalasia, some authors recommend keeping the child in a vertical position for days( in a semi-sitting position, in pillows, with the help of special devices).Children after 3 years are also recommended to feed more thick in consistency food, smaller portions and more often. It is not recommended to lie down after meals. Children of all ages are advised to sleep in a position with an elevation of the upper half of the body or half-sitting.
Inside is appointed cerucal( synonyms: metoclopramide, raglan, ephedra, maxeran, etc.), which provides faster evacuation of food from the stomach, strengthens the motor of the latter and thereby reduces the hyperacid stasis. Due to the fact that the drug causes dry mouth and drowsiness, the children are prescribed under the constant supervision of a doctor in doses: up to 3 years - 1/8 tablets 2 times a day, 3 to 6 years - 1/4 tablets 3 times aDay, over 6 years - for ½-1 tablet 2-3 times a day. Cerucal helps increase the tone and tension of the lower esophageal sphincter, as well as the contractility of the muscles of the esophagus.
The use of antacids is shown, as, by reducing the acidity of gastric juice, they provide an increase in gastrin production. The latter increases the pressure in the cardia.
However, to strive for sharp alkalization of the gastric contents should not be, because in children with a deficiency of the cardinal sphincter, a considerable inhibition of gastritis production and a decrease in the sensitivity of the cardia to gastrin are observed.
The use of antacids prevents the occurrence and development of reflux esophagitis.
Prognosis for achalasia in most cases in the absence of reflux esophagitis favorable. The rapid disappearance of achalasia is facilitated by timely vigorous treatment of background diseases, which were mentioned above. However, severe forms of cardia failure do not lend themselves to conservative therapy and require the use of surgical treatment.