ORIGINAL ARTICLES   

Chirurgia 2007 June;20(3):125-9

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: English

Achalasia in Nigeria. Current status

Ezemba N., Ekwunife C. N., Eze J. C.

Division of Cardiothoracic Surgery University of Nigeria Teaching Hospital, Enugu

Aim. The literature on achalasia of the oesophagus in Nigeria is scanty. Earlier reviews from different centres in the country have all docummented both late presentation and advanced stages of the disease. It is now over two decades since the last review of this disorder in our centre. Notable changes including advent of thoracoscopic and laparoscopic oesophagocardiomyotomy have occurred during this period. This study reviews the current state of achalasia in the country.
Methods. This is a descriptive retrospective study of all cases of idiopathic achalasia admitted into the National Cardio thoracic centre, University of Nigeria Teaching Hospital, Enugu over a 15-year period (1990-2004).
Results. Forty –three patients were admitted for achalasia during the period. Forty case notes were available for review. The age range was 18months - 76 years with mean of 36.96 years and male: female sex ratio of 1:1. Sixty percent of cases were in the 3rd –5th decades of life. Childhood achalasia accounted for 12.5% of cases. The mean symptom duration at presentation was 7.4 years. Progressive dysphagia initially to solid remained the major symptom. Bilateral parotid sialodenosis were present in 7/40 (17%). Ninety three percent of patients presented with stages III and IV disease. Treatment was by transthoracic modified Heller’s oesophagocardiomyotomy with operative mortality of 5% and intra-operative oesophageal perforation of 15%. Excellent/good results were achieved in over 80% of cases.
Conclusions. The Nigerian patient with achalasia continues to present both late and with advanced stages of the disease. Although diagnosis can be established by radiology, endoscopy should be routinely added in the peri-operative evaluation. Modified Heller’s procedure without routine anti-reflux surgery and with care to prevent intra-operative oesophageal perforation offer good result even in sigmoid achalasia.