Case reports
Esophageal atresia and achalasialike esophageal dysmotility

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Abstract

A 14-year-old boy presented with regurgitation, malnutrition, and chronic lung insufficiency with a history of successful repair of esophageal atresia and tracheoesophageal fistula in the newborn period. Barium swallow and manometry results showed achalasia. Hellar operation with antireflux procedure resulted in complete symptomatic relief. Histology and immunohistochemistry including PGP9.5, MAP5, cKit, and nNOS of myotomy specimen showed intact innervation. Although esophageal dysmotility after esophageal atresia repair usually is caused by gastroesophageal reflux and incoordination of peristalsis, the possibility of achalasia should also be considered, because a casual relationship between esophageal atresia and achalasia may exist.

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Case report

This 14-year-old Chinese boy had esophageal atresia and tracheoesophageal fistula diagnosed at birth, which were repaired on day 3 of life. Since the age of 5 months, recurrent nocturnal wheezing and coughing developed. He also had copious regurgitated saliva and food residue, which were mistaken as sputum by his parents. He then was treated with intermittent bronchodilator therapy as for asthma. Moreover, at 6 months, 8 years and 13 years of age, respectively, he had pneumonia that required

Discussion

Esophageal dysmotility is common in children with esophageal atresia and presents frequently as gastroesophageal reflux (GER). The incidence of GER varies from 41% based on symptoms only1 to 68% measured by pH monitor, 72% by Ba swallow, and 65% by scintiscan.2 The dysmotility may be congenital. Preoperative cinefluorographic study showed abnormal esophageal motility in children with esophageal atresia, suggesting preexisting neuromuscular abnormality of the esophagus in children with

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