[Achalasia in children and adolescents, a therapeutic challenge]

Treatment of achalasia in children is in permanent discussion. It is a rare disorder without cure, which makes its management challenging.

Retrospective review of patients under 18 years old treated for achalasia in our Hospital between 2000 and 2012, by either pneumatic dilatation (PD) or Heller myotomy (HM).

Thirteen children were treated during this time. Mean age was 12 years (4-18), interval time between the onset of symptoms and diagnosis was 15 months (2-48) and mean follow-up was 66,8 months (4-144). Dysphagia and vomits were the main symptoms (61%). A single PD was performed in 5 patients; four were the oldest children of the series (16-18). Three girls remain asymptomatic and 2 boys suffer from moderate dysphagia. Six patients required multiple PD and, after a mean of 3 dilatations, HM was needed in all of them. The last 2 children of the series received surgery as the first treatment. In total, eight patients underwent HM and fundoplication, with 6 laparoscopic procedures. Two boys suffer from low-moderate dysphagia, but additional treatments have not been required. The mean of total hospital stay was 12,7 days (2-45) for PD and 9 days (3-30) for HM. Two patients were reoperated because of oesophagic perforation, one after PD and one after open HM.

Although PD and HM could be complementary, laparoscopic Heller myotomy should be considered the first therapeutic option, specially in young boys.