Abstract
The esophagus, which plays a primary role in food transport, is a collapsible organ with three main sections: upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES). This chapter details basic pathophysiologic aspects of four disorders of esophageal motility, esophageal achalasia, esophageal spasm, nutcracker esophagus, and eosinophilic esophagitis and briefly describes nonspecific esophageal motility disorders. Each disorder causes different eating and digestive symptoms (dysphagia, abdominal and chest pain, heart burn, regurgitation of digested food) and may appear to mimic GERD or esophageal reflux. In some disorders, such as achalasia, much of the literature is based on the adult population, while pediatric information is noted only in case and retrospective studies. On the other hand, eosinophilic esophagitis is more prevalent in the pediatric population and may be related to food and environmental allergens. Diffuse esophageal spasm and nutcracker esophagus are benign and very rare in the pediatric population.
Prior to diagnosis, endoscopy, and fluoroscopy rule out organic pathology. Esophageal manometry is then used as the primary assessment method of esophageal motor activity or contractions, UES and LES pressures, esophageal body contraction amplitude, and peristaltic sequence. Bolus transit and clearance are evaluated by videocineroentgenography or videofluorography, esophageal transit scintigraphy, impedance, and pH monitoring. Esophageal function testing, a union of manometry and multichannel intraluminal impedance monitoring, gathers information on bolus transit patterns, swallow-associated events, nonobstructive dysphagia, chest pain, and general motility disorder.
Treatment for most esophageal disorders focuses on relieving symptoms and improving the quality of life rather than curing the disorder. Primary treatments are pharmacologic, endoscopic, and surgical. Medications may improve symptoms; esophageal dilation is one of the most successful nonsurgical treatments, and in some cases, dietary management is effective; and surgical approaches can reduce LES pressure, alleviate pain, and decrease severity of symptoms.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kahrilas PJ, et al. Upper esophageal spincter function during deglutition. Gastroenterology. 1988;95(1):52–62.
Sivarao DV, Goyal RK. Functional anatomy and physiology of the upper esophageal sphincter. Am J Med. 2000;108(Suppl 4a):27S–37.
Kuo B, Urma D. Esophagus—anatomy and development. In: Goyal RK, Shaker R, editors. Goyal and Shaker’s GI Motility Online. New York: Nature Publishing Group; 2006.
Miller MJ, Kiatchoosakun P. Relationship between respiratory control and feeding in the developing infant. Semin Neonatol. 2004;9(3):221–7.
Holloway RH. Esophageal body motor response to reflux events: secondary peristalsis. Am J Med. 2000;108(Suppl 4a):20S–6.
Passaretti S, et al. Standards for oseophageal manometry. A position statement from the gruppo italinao di studio motilita apparato digerente (gismad). Dig Liver Dis. 2000;32(1):46–56.
Katz P, Menin R, Gideon R. Utility and standards in esophageal manometry. J Clin Gastroenterol. 2008;42(5):620–6.
Chitkara DK, Fortunado C, Nurko S. Prolonged monitoring of esophageal motor function in healthy children. J Pediatr Gastroenterol Nutr. 2004;38(2):192–7.
Tutuian R, et al. Symptom and function heterogenicity among patients with distal esophageal spam: studies using combined impedance-manometry. Am J Gastroenterol. 2006;101:464–9.
Gideon R. Manometry: technical issues. Gastrointest Endosc Clin N Am. 2005;15(2):243–55.
Bremner RM, et al. Normal esophageal body function: a study using ambulatory esophageal monometry. Am J Gastroenterol. 1998;93:183–7.
Pursnani K, et al. Comparison of lower oesophageal sphincter pressure measurement using circumferential vs unidirectional transducers. Neurogastroenterol Motil. 1997;9(3):177–80.
Russo S, et al. Videofluorography swallow study of patients with systemic sclerosis. Gastrointest Radiol. 2009;114:948–59.
Fordham LA. Imaging of the esophagus in children. Radiol Clin North Am. 2005;43(2):283–302.
Levine MS, Rubesine SE, Laufer I. Barium esophagography: a study for all seasons. Clin Gastroenterol Hepatol. 2008;6(1):11–25.
Summerton SL. Radiographic evaluation of esophageal function. Gastrointest Endosc Clin N Am. 2005;15(2):231–42.
Schima W, et al. Esophageal motor disorders: videofluoroscopic and manometric evaluation-prospective study in 88 symptomatic patients. Radiology. 1992;185:487–91.
Mariani G, et al. Radionucleotide gastroesophageal motor studies. J Nucl Med. 2004;15(2):231–42.
Iascone C, et al. Use of radiographic esophageal transit in the assessment of patients with symptoms of reflux and non-specific esophageal motor disorders. Dis Esophagus. 2004;17(3):218–22.
Imam H, et al. Bolus transit patterns in healthy subjects: a study using simultaneous impedance monitoring, vidoesophagram, and esophageal manometry. Am J Physiol Gastrointest Liver Physiol. 2005;288(5):G1000–6.
Brednoord AJ, et al. Technology review: esophageal impedance monitoring. Am J Gastroenterol. 2007;102(1):187–94.
Bredneoord AJ, Smout AJ. Esophageal motility testing: impedance-based transit measurement and high-resolution manomotry. Gastroenterol Clin North Am. 2008;37(4):775–91.
Tutuian R, Castell DO. Esophageal function testing: role of combined multichannel intraluminal impedance and manometry. Gastrointest Endosc Clin N Am. 2005;4:265–75.
Savarino E, Tutuian R. Combined multichannel intraluminal impedance and manometry testing. Dig Liver Dis. 2008;40(3):167–73.
Glassman MS, et al. Spectrum of esophageal disorders in children with chest pain. Dig Dis Sci. 1992;37(5):663–6.
Prasse JE, Kikano GE. An overview of pediatric dysphagia. Clin Pediatr. 2009;48(3):247–51.
Lawal A, Shaker R. Esophageal dysphagia. Phys Med Rehabil Clin N Am. 2008;19:729–45.
Lefton-Greif MA. Pediatric dysphagia. Phys Med Rehabil Clin N Am. 2008;19(4):837–51.
Berezin S, et al. Chest pain of gastrointestinal origin. Arch Dis Child. 1988;63:1457–60.
Eslick GD. Classification, natural history, epidemiology, and risk factors of noncardiac chest pain. Dis Mon. 2008;54(9):593–603.
Webb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc. 1995;41(1):39–51.
Macpherson RI, et al. Esophageal foreign bodies in children: diagnosis, treatment, and complications. Am J Roentgenol. 1996;166:919–24.
Ghosh SK, et al. Oesophageal peristaltic transition zone defects: real but few and far between. Neurogastroenterol Motil. 2008;20(12):1283–90.
Sadowski DC, et al. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22(9):256–61.
Mayberry JF, Mayell MJ. Epidemiological study of achalasia in children. Gut. 1988;29(1):90–3.
Myers NA, Jolley SG, Taylor R. Achalasia of the cardia in children: a worldwide survey. J Pediatr Surg. 1994;29(10):1375–9.
Asch MJ, et al. Esophageal achalasia: diagnosis and cardiomyotomy in a newborn infant. J Pediatr Surg. 1974;9(6):911–2.
Kraichely RE, Farrugia G. Achalasia: physiology and etiopathogenesis. Dis Esophagus. 2006;19(4):213–23.
Goldblum JR, Rice TW, Richter JE. Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology. 1996;111(3):648–54.
Bohl J, et al. Childhood achalasia: a separate entity? Z Gastroenterol. 2007;45(12):1273–80.
Herbella FA, Oliveira DR, Del Grande JC. Are idiopathic and Chagasic achalasia two different diseases? Dig Dis Sci. 2004;49(3):353–60.
Wallace RA. Clinical audit of gastrointestinal conditions occurring among adults with Down syndrome attending a specialist clinic. J Intellect Dev Disabil. 2007;32(1):45–50.
Kelly JL, et al. Coexistent Hirschsprung’s disease and esophageal achalasia in male siblings. J Pediatr Surg. 1997;32(12):1809–11.
Kimber J, et al. Allgrove or 4 “A” syndrome: an autosomal recessive syndrome causing multisystem neurological disease. J Neurol Neurosurg Psychiatry. 2003;74(5):654–7.
Brooks AS, et al. Homozygous nonsense mutations in KIAA1279 are associated with malformations of the central and enteric nervous systems. Am J Hum Genet. 2005;77(1):120–6.
Khelif K, et al. Achalasia of the cardia in Allgrove’s (triple A) syndrome: histopathologic study of 10 cases. Am J Surg Pathol. 2003;27(5):667–72.
Moses PL, et al. Antineuronal antibodies in idiopathic achalasia and gastro-oesophageal reflux disease. Gut. 2003;52(5):629–36.
Pohl D, Tutuian R. Achalasia: an overview of diagnosis and treatment. J Gastrointestin Liver Dis. 2007;16(3):297–303.
Rosen R, Nurko S. Other motor disorders. In: Walker WA, editor. Pediatric gastrointestinal disease. Hamilton: BC Decker Inc; 2004. p. 424–62.
Dabritz J, et al. Achalasia mistaken as eating disorders: report of two children and review of the literature. Eur J Gastroenterol Hepatol. 2010;22(7):775–8.
Berquist WE, et al. Achalasia: diagnosis, management, and clinical course in 16 children. Pediatrics. 1983;71(5):798–805.
Parkman HP, et al. Optimal evaluation of patients with nonobstructive esophageal dysphagia. Manometry, scintigraphy, or videoesophagography? Dig Dis Sci. 1996;41(7):1355–68.
Blam ME, et al. Achalasia: a disease of varied and subtle symptoms that do not correlate with radiographic findings. Am J Gastroenterol. 2002;97(8):1916–23.
Eckardt AJ, Eckardt VF. Current clinical approach to achalasia. World J Gastroenterol. 2009;15(32):3969–75.
Liu W, et al. The pathogenesis of pseudoachalasia: a clinicopathologic study of 13 cases of a rare entity. Am J Surg Pathol. 2002;26(6):784–8.
Castell JA, Gideon MR, Castell DO. Esophageal manometry. In: Schuster MM, editor. Atlas of gastrointestinal motilily in health and disease. Hamilton: BC Decker; 2002. p. 69–85.
Pandolfino JE, Kahrilas PJ. AGA technical review on the clinical use of esophageal manometry. Gastroenterology. 2005;128(1):209–24.
Pandolfino JE, Kwiatek MA, Nealis T. Achalasia: a new clinically relevant classification by high resolution manometry. Gastroenterology. 2008;135:1526–33.
Williams VA, Peters JH. Achalasia of the esophagus: a surgical disease. J Am Coll Surg. 2009;208(1):151–62.
Jung C, et al. Treatments for pediatric achalasia: Heller myotomy or pneumatic dilatation? Gastroenterol Clin Biol. 2010;34(3):202–8.
Vaezi MF, Richter JE. Current therapies for achalasia: comparison and efficacy. J Clin Gastroenterol. 1998;27(1):21–35.
Maksimak M, Perlmutter DH, Winter HS. The use of nifedipine for the treatment of achalasia in children. J Pediatr Gastroenterol Nutr. 1986;5(6):883–6.
Efrati Y, et al. Radionuclide esophageal emptying and long-acting nitrates (Nitroderm) in childhood achalasia. J Pediatr Gastroenterol Nutr. 1996;23(3):312–5.
Smith H, et al. The use of nifedipine for treatment of achalasia in children. J Pediatr Gastroenterol Nutr. 1988;7(1):146.
Pasricha PJ, et al. Treatment of achalasia with intrasphincteric injection of botulinum toxin. A pilot trial. Ann Intern Med. 1994;121(8):590–1.
Pasricha PJ, et al. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med. 1995;332(12):774–8.
Pasricha PJ, et al. Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology. 1996;110(5):1410–5.
Khoshoo V, LaGarde DC, Udall Jr JN. Intrasphincteric injection of Botulinum toxin for treating achalasia in children. J Pediatr Gastroenterol Nutr. 1997;24(4):439–41.
Walton JM, Tougas G. Botulinum toxin use in pediatric esophageal achalasia: a case report. J Pediatr Surg. 1997;32(6):916–7.
Hurwitz M, et al. Evaluation of the use of botulinum toxin in children with achalasia. J Pediatr Gastroenterol Nutr. 2000;30(5):509–14.
Ip KS, et al. Botulinum toxin for achalasia in children. J Gastroenterol Hepatol. 2000;15(10):1100–4.
Katzka DA, Castell DO. Use of botulinum toxin as a diagnostic/therapeutic trial to help clarify an indication for definitive therapy in patients with achalasia. Am J Gastroenterol. 1999;94(3):637–42.
Smith CD, et al. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg. 2006;243(5):579–84. discussion 584–6.
Vantrappen G, Janssens J. To dilate or to operate? That is the question. Gut. 1983;24(11):1013–9.
Campos GM, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249(1):45–57.
Kadakia SC, Wong RK. Pneumatic balloon dilation for esophageal achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):325–46. vii.
West RL, et al. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97(6):1346–51.
Chan KC, et al. Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years’ experience. Endoscopy. 2004;36(8):690–4.
Karamanolis G, et al. Long-term outcome of pneumatic dilation in the treatment of achalasia. Am J Gastroenterol. 2005;100(2):270–4.
Zhao JG, et al. Long-term safety and outcome of a temporary self-expanding metallic stent for achalasia: a prospective study with a 13-year single-center experience. Eur Radiol. 2009;19(8):1973–80.
Ali A, Pellegrini CA. Laparoscopic myotomy: technique and efficacy in treating achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):347–58. vii.
Patti MG, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg. 1998;2(6):561–6.
Stewart KC, et al. Thoracoscopic versus laparoscopic modified Heller Myotomy for achalasia: efficacy and safety in 87 patients. J Am Coll Surg. 1999;189(2):164–9. discussion 169–70.
Spechler SJ. AGA technical review on treatment of patients with dysphagia caused by benign disorders of the distal esophagus. Gastroenterology. 1999;117(1):233–54.
Malthaner RA, et al. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg. 1994;58(5):1343–6. discussion 1346–7.
Jara FM, et al. Long-term results of esophagomyotomy for achalasia of esophagus. Arch Surg. 1979;114(8):935–6.
Csendes A, et al. Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut. 1989;30(3):299–304.
Kostic S, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg. 2007;31(3):470–8.
Csendes A, et al. Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg. 2006;243(2):196–203.
Richards WO, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240(3):405–12. discussion 412–5.
Zerbib F, et al. Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia. Am J Gastroenterol. 2006;101(4):692–7.
Vela MF, et al. The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol. 2006;4(5):580–7.
Zaninotto G, et al. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248(6):986–93.
Jeansonne LO, et al. Ten-year follow-up of laparoscopic Heller myotomy for achalasia shows durability. Surg Endosc. 2007;21(9):1498–502.
Lopushinsky SR, Urbach DR. Pneumatic dilatation and surgical myotomy for achalasia. JAMA. 2006;296(18):2227–33.
Askegard-Giesmann JR, et al. Minimally invasive Heller’s myotomy in children: safe and effective. J Pediatr Surg. 2009;44(5):909–11.
Mehra M, et al. Laparoscopic and thoracoscopic esophagomyotomy for children with achalasia. J Pediatr Gastroenterol Nutr. 2001;33(4):466–71.
Rothenberg SS, et al. Evaluation of minimally invasive approaches to achalasia in children. J Pediatr Surg. 2001;36(5):808–10.
Patti MG, et al. Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children. J Pediatr Surg. 2001;36(8):1248–51.
Litle VR. Laparoscopic Heller myotomy for achalasia: a review of the controversies. Ann Thorac Surg. 2008;85(2):S743–6.
Tannuri AC, et al. Laparoscopic extended cardiomyotomy in children: an effective procedure for the treatment of esophageal achalasia. J Pediatr Surg. 2010;45(7):1463–6.
Corda L, et al. Laparoscopic oesophageal cardiomyotomy without fundoplication in children with achalasia: a 10-year experience: a retrospective review of the results of laparoscopic oesophageal cardiomyotomy without an anti-reflux procedure in children with achalasia. Surg Endosc. 2010;24(1):40–4.
Adikibi BT, et al. Intraoperative upper GI endoscopy ensures an adequate laparoscopic Heller’s myotomy. J Laparoendosc Adv Surg Tech A. 2009;19(5):687–9.
Jafri M, et al. Intraoperative manometry during laparoscopic Heller myotomy improves outcome in pediatric achalasia. J Pediatr Surg. 2008;43(1):66–70. discussion 70.
Tovar JA, et al. Esophageal function in achalasia: preoperative and postoperative manometric studies. J Pediatr Surg. 1998;33(6):834–8.
Pensabene L, Nurko S. Approach to the child who has persistent dysphagia after surgical treatment for esophageal achalasia. J Pediatr Gastroenterol Nutr. 2008;47(1):92–7.
Zaninotto G, et al. Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann Surg. 2002;235(2):186–92.
Zaninotto G, et al. Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg. 2000;4(3):282–9.
Zaninotto G, et al. Minimally invasive surgery for esophageal achalasia. J Laparoendosc Adv Surg Tech A. 2001;11(6):351–9.
Sandler RS, et al. The risk of esophageal cancer in patients with achalasia. A population-based study. JAMA. 1995;274(17):1359–62.
Dunaway PM, Wong RK. Risk and surveillance intervals for squamous cell carcinoma in achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):425–34. ix.
Zendehdel K, et al. Risk of esophageal adenocarcinoma in achalasia patients, a retrospective cohort study in Sweden. Am J Gastroenterol. 2011;106(1):57–61.
Brucher BL, et al. Achalasia and esophageal cancer: incidence, prevalence, and prognosis. World J Surg. 2001;25(6):745–9.
Leeuwenburgh I, et al. Long-term esophageal cancer risk in patients with primary achalasia: a prospective study. Am J Gastroenterol. 2010;105(10):2144–9.
Eckardt VF, Hoischen T, Bernhard G. Life expectancy, complications, and causes of death in patients with achalasia: results of a 33-year follow-up investigation. Eur J Gastroenterol Hepatol. 2008;20(10):956–60.
Fontan JP, et al. Esophageal spasm associated with apnea and bradycardia in an infant. Pediatrics. 1984;73(1):52–5.
Sperandio M, et al. Diffuse esophageal spasm: not diffuse but distal esophageal spasm (des). Dig Dis Sci. 2003;48(7):1380–4.
Smout AJ. Advances in esophageal motor disorder. Curr Opin Gastroenterol. 2008;24:285–9.
Tutuian R, Castell DO. Review article: oesophageal spasm-diagnosis and management. Aliment Pharmacol Ther. 2006;23(10):1393–402.
Adler DG, Romero Y. Primary esophageal motility disorders. Mayo Clin Proc. 2001;76(2):195–200.
Grubel C, et al. Diffuse esophageal spasm. Am J Gastroenterol. 2008;103:450–7.
Rosen J, et al. Diffuse esophageal spasm in children (abstract). J Pediatr Gastroenterol Nutr. 2005;41(4):561.
Hussain SZ, Di Lorenzo C. Motility disorders. Diagnosis and treatment for the pediatric patient. Pediatr Clin North Am. 2002;49(1):27–51.
Herbella FAM, et al. Primary versus secondary esophageal motility disorders: diagnosis and implications for treatment. J Laparoendosc Adv Surg Tech A. 2009;19(2):195–8.
Allen ML, DiMarino AJ. Manometric diagnosis of diffuse esophageal spasm. Dig Dis Sci. 1996;41(7):1346–9.
Lacy BE, Weiser K. Esophageal motility disorders: medical therapy. J Clin Gastroenterol. 2008;2(5):652–8.
Putnam PE. Eosinophilic esophagitis in children: clinical manifestations. Gastroenterol Clin North Am. 2008;37:369–81.
Markowitz JE, Liacouras CA. Eosinophilic esophagitis. Gastroenterol Clin North Am. 2003;32(2003):949–66.
Nurko S, Rosen R, Furuta GT. Esophageal dysmotility in children with esoinophilic esophagitis: a study using prolonged esophageal manometery. Am J Gastroenterol. 2009;104:3050–7.
Rothenberg ME. Biology and treatment of eosinophilic esophagitis. Gastroenterology. 2009;137:1238–49.
Orenstein SR, et al. The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol. 2000;95:1422–30.
Xu X, et al. Mast cells and eosinophils have a potential profibrogenic role in Crohn Disease. Scand J Gastroenterol. 2004;39:440–7.
Nurko S, Rosen R. Esophageal dysmotility in patients who have eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008;18(1):73–89. ix.
Dohil R, et al. Oral viscuous budesonide is effective in children with eosinophilic esophagits in a randomized, placedbo-controlled trail. Gastroenterology. 2010;139:418–29.
Hejazi RA, et al. Disturbances of esophageal motility in esoinophilic esophagitis: a case series. Dysphagia. 2010;25:231–7.
Zagai U, et al. The effect of eosinophils on collagen gel contraction and implications for tissue remodeling. Clin Exp Immunol. 2004;135:427–33.
Straumann A. The natural history and complications fo esoinophilic esophagits. Gastrointest Endosc Clin N Am. 2008;18(1):99–118.
Shah A, Hirano I. Treatment of esosinophilic esophagitis: drugs, diet, or dilation? Curr Gastroenterol Rep. 2007;9(3):181–8.
Putnam PE. Evaluation of the child who has eosinophilic esophagitis. Immunol Allergy Clin North Am. 2009;29:1–10.
Liacouras CA. Eosinophilic esophagitis. Curr Opin Pediatr. 2004;16(5):560–6.
Aceves SS, Furuta GT, Spechler SJ. Integrated approach to treatment of children and adults with eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008;18:195–217.
Ntoumazios SK, et al. Esophageal involvement in scleroderma: gastroesophageal reflux, the common problem. Semin Arthritis Rheum. 2006;36:173–81.
Duraj V, et al. Esophageal damages in systemic scleroderma (abstract). Med Arch. 2007;61(1):47–8.
Vancheeswaran R, et al. Childhood-onset secleroderma: is it different from adult-onset disease? Arthritis Rheum. 1996;39(6):1041–9.
Denton CP, Derrett-Smith EC. Juvenile-onset systemic sclerosis: children are not small adults. Rheumatology. 2008;48:96–7.
Foeldvari I, et al. Favourable outcome in 135 children with juvenile systemic sclerosis: results of a multi-national survey. Rheumatology. 2000;39:556–9.
Weber P, et al. Twenty-four hour intraesophageal pH monitoring in children and adolescents with scleroderma and mixed connective tissue disease (abstract). J Rheumatol. 2000;27(11):2692–5.
Gunawardena H, McHugh N. Features and recommended treatment of systemic sclerosis. Prescriber. 2008;19(18):56–65.
Hedrich CM, et al. Presentations and treatment of childhood scleroderma: Localized scleroderma, eosinophilic fasciitis, systemic sclerosis, and graft-versus-host disease. Clin Pediatr (Phila). 2011;50(7):604–14.
Domsic R, Fasanella K, Bielefeldt K. Gastrointestinal manifestations of systemic sclerosis. Dig Dis Sci. 2008;53:1163–74.
Antonucci A, et al. Chronic intestinal pseudo-obstruction. World J Gastroenterol. 2008;14(19):2953–61.
Boige N, et al. Manometrical evaluation in visceral neuropathies in children. J Pediatr Gastroenterol Nutr. 1994;19(1):71–7.
Panganamamula KV, Parkman HP. Chronic pseudo-obstruction. Curr Treat Options Gastroenterol. 2005;8:3–11.
Byrne WJ, et al. Chronic idiopathic intestinal pseudo-obstruction syndrome in children—clinical characteristics and prognosis. J Pediatr. 1977;90(4):585–9.
de Lorijn F, Boechxstaens GE, Benninga MA. Symptomatology, pathophysiology, diagnostic work-up, and treatment of Hirschsprung disease in infancy and childhood. Curr Gastroenterol Rep. 2007;9:245–53.
Faure C, et al. Duodenal and esophageal manometry in total colonic aganglionosis. J Pediatr Gastroenterol Nutr. 1994;18(2):193–9.
Staiano A, et al. Esophageal motility in children with Hirschsprung’s disease. Am J Dis Child. 1991;145(3):310–3.
Karagiozoglou-Lampoudi T, et al. Conservative management of caustic substance ingestion in a pediatric department setting, short-term and long-term outcome. Dis Esophagus. 2010;2(42):86–91.
Sanchez-Ramirez CA, et al. Caustic ingestion and oesophageal damage in children: clinical spectrum and feeding practices. J Pediatr Child Health. 2011;47(6):378–80.
Dantas RO, Mamede RC. Esophageal motility in patients with esophageal caustic injury. Am J Gastroenterol. 1996;91(6):1157–61.
Genc A, Mutaf O. Esophageal motility changes in acute and late periods of caustic esophageal burns and their relation to prognosis in children. J Pediatr Surg. 2002;37(11):1526–8.
Spechler SJ, Castell D. Classification of oesophageal motility abnormalities. Gut. 2001;49:145–51.
Mittal KR. Motor and sensory function of the esophagus: revelations through ultrasound imaging. J Clin Gastroenterol. 2005;39 Suppl 2:S42–8.
Kim JH, et al. Is all ineffective esophageal motility the same? A clinical and high-frequency intraluminal US study. Gastrointest Endosc. 2008;68:422–31.
Botoman VA. How effective are we at understanding ineffective esophageal motility? Gastrointest Endosc. 2008;68(3):432–3.
Leite LP, et al. Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci. 1997;42(9):1859–65.
Naftali T, et al. Nonspecific esophageal motility disorders may be an early stage of a specific disorder, particularly achalasia. Dis Esophagus. 2009;22:611–5.
Rosario JA, et al. Nonspecific esophageal motility disorders in children without gastroesophageal reflux. J Pediatr Gastroenterol Nutr. 1999;28(5):480–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Mousa, H., Aspirot, A. (2013). Esophageal Motor Disorders: Achalasia, Diffuse Esophageal Spasm, Nonspecific Motor Disorders, Eosinophilic Esophagitis. In: Faure, C., Di Lorenzo, C., Thapar, N. (eds) Pediatric Neurogastroenterology. Clinical Gastroenterology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-709-9_20
Download citation
DOI: https://doi.org/10.1007/978-1-60761-709-9_20
Published:
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-60761-708-2
Online ISBN: 978-1-60761-709-9
eBook Packages: MedicineMedicine (R0)