Published online Apr 16, 2014. doi: 10.4253/wjge.v6.i4.105
Revised: February 25, 2014
Accepted: March 11, 2014
Published online: April 16, 2014
Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.
Core tip: Achalasia is a neurodegenerative disorder of the lower esophageal sphincter which occurs less commonly in children compared to adults and patients present with progressive dysphagia, vomiting, and weight loss. Medical therapy including botulinum toxin injection and endoscopic dilatation have been associated with only transient relief of dysphagia symptoms as is also seen in adults. While current evidence also suggests that the surgical approach of laparoscopic Heller myotomy provides lasting benefits for children with achalasia, future prospective evaluation will need to be conducted to ascertain whether peroral endoscopic myotomy is safe and equally effective in children.