Case Report

Cricopharyngeal Achalasia Responsive to Balloon Dilation in an Infant

Authors: Dereck Davis, MD, Michael Nowicki, MD, Henry Giles, MD

Abstract

This report describes an infant with vomiting and significant weight loss attributable to cricopharyngeal achalasia, a rare finding in children. The infant responded to balloon dilation of the upper esophageal sphincter, with resolution of symptoms and return to presymptomatic growth parameters. A brief description of the clinical features, diagnostic evaluation, and treatment options for cricopharyngeal achalasia is included.


Key Points


* Cricopharyngeal achalasia is rare in children and may be associated with serious underlying disorders of the central nervous system.


* The presence of a posterior pharyngeal bar is highly suggestive of cricopharyngeal achalasia, but other causes of oropharyngeal dysfunction must be excluded.


* Treatment should be tailored to the patient’s disease severity; options include injection withBotulinum toxin, balloon dilation, and myotomy.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Mathur NB, Banerjee S, Maria A, et al. Congenital cricopharyngeal achalasia. Indian Pediatr2001;38:783–788.
 
2. Blank RH, Silbiger M. Cricopharyngeal achalasia as a cause of respiratory distress in infancy. J Pediatr 1972;81:95–98.
 
3. Reichert TJ, Bluestone CD, Stool SE, et al. Congenital cricopharyngeal achalasia. Ann Otol1977;86:603–610.
 
4. Lernau OZ, Sherzer E, Mogle P, et al. Congenital cricopharyngeal achalasia treatment by dilations. J Pediatr Surg 1984;19:202–203.
 
5. Pollack IF, Pang D, Kocoshis S, et al. Neurogenic dysphagia resulting from Chiari malformations: experimental and clinical study. Neurosurgery 1992;30:709–719.
 
6. Gendell HM, McCallum JE, Reigel DH. Cricopharyngeal achalasia associated with Arnold-Chiari malformations in childhood. Child Brain 1978;4:65–73.
 
7. Kornblum C, Broicher R, Walther E, et al. Cricopharyngeal achalasia is a common cause of dysphagia in patients with mtDNA deletions. Neurology 2001;56:1409–1412.
 
8. Weitz R, Varsano I, Geifman M, et al. Cricopharyngeal achalasia associated with congenital suprabulbar paresis. Helv Paediat Acta 1976;311:271–274.
 
9. Dietz F, Logeman JA, Sahgal V, et al. Cricopharyngeal muscle dysfunction in the differential diagnosis of dysphagia in polymyositis. Arthritis Rheum 1980;23:491–495.
 
10. Kagen LJ, Hochman RB, Strong EW. Cricopharyngeal obstruction in inflammatory myopathy (polymyositis/dermatomyositis): report of three cases and review of the literature. Arthritis Rheum1985;28:630–636.
 
11. Skinner MA, Shorter NA. Primary neonatal cricopharyngeal achalasia: a case report and review of the literature. J Pediatr Surg 1992;27:1509–1511.
 
12. Dantas RO, Cook IJ, Dodds WJ, et al. Biomechanics of cricopharyngeal bars. Gastroenterology1990;99:1269–1274.
 
13. Blitzer A, Brin MF. Use of botulinum toxin for diagnosis and management of cricopharyngeal achalasia. Otolaryngol Head Neck Surg 1997;116:328–330.
 
14. Solt J, Bajor J, Moizs M, et al. Primary cricopharyngeal dysfunction: treatment with balloon catheter dilatation. Gastrointest Endosc 2001;54:767–771.
 
15. Muraji T, Takamizawa S, Satoh S, et al. Congenital cricopharyngeal achalasia: diagnosis and surgical management. J Pediatr Surg 2002;37:E12–E14.
 
16. Brooks A, Millar AJW, Rode H. The surgical management of cricopharyngeal achalasia in children.Int J Pediatr Otolaryngol 2000;56:1–7.