Achalasia: Diagnosis, Management, and Clinical Course in 16 Children

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Abstract
Clinical features, radiographic and esophageal manometry findings and treatment results in 16 patients < 15 yr old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: increased resting lower esophageal sphincter pressure, incomplete or failure of relaxation of the lower esophageal sphincter on swallowing and ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15 postprandial vomiting in 13 and retrosternal pain in 5. The average duration from onset of symptoms to diagnosis was 28 mo. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in 8 and was successful for > 1 yr in 5. Two patients required 2 dilations and were then symptom-free for > 1 yr, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the 2nd dilation. Three patients underwent myotomy and 2 patients had myotomy with fundoplication as initial treatment; only 1 remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if > 2 dilations are required within 1 yr, surgical management is recommended.