Achalasia is a condition in which the ring of muscle (lower esophageal sphincter) at the bottom of the esophagus (food pipe) fails to relax properly, making it difficult for food to pass into the stomach. Although rare in children, it can occur in various age groups.

Achalasia is very rare in children and is more commonly seen in adults. Its prevalence in children is around 1–2%. However, diagnosis in children is often more challenging and therefore delayed. Delayed diagnosis can lead to permanent abnormal contractions in the esophagus, making treatment more difficult and prolonged.

Symptoms

Symptoms include difficulty swallowing, vomiting, chest pain while eating, weight loss, and nighttime coughing. Because it is rare in children, diagnosis is often difficult. Without timely diagnosis and treatment, children may develop malnutrition-related growth and developmental delays, asthma-like symptoms (such as chronic cough and shortness of breath) due to aspiration of esophageal contents into the airway, and permanent impairment of esophageal function.

Treatment

Medication usually does not provide a permanent solution. The most effective treatment for achalasia is surgical intervention. The thick muscular layer at the lower end of the esophagus is thinned to allow easier passage of food and liquids into the stomach. Currently, the preferred treatment worldwide is laparoscopic (minimally invasive) surgery performed in experienced centers.

Complications from laparoscopic surgery are rare. These may include bleeding, esophageal leakage, and gastroesophageal reflux. To prevent reflux (the backward flow of stomach contents into the esophagus), an anti-reflux procedure should routinely be performed during laparoscopic achalasia surgery.

Early diagnosis and appropriate treatment reduce the negative effects of achalasia on children and improve their quality of life. If a child shows symptoms of achalasia, evaluation by a pediatric gastroenterologist or pediatric surgeon is essential.

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