An infant with nasal regurgitation since birth and failure to thrive

The condition achalasia cardia is rare in paediatric age group, especially in infants. An 11-month-old female infant presented with complaints of oronasal regurgitation since birth and failure to thrive. Upper GI contrast study was conducted which demonstrated massive dilatation of lower 2/3(rd) of oesophagus with abrupt narrowing at lower oesophageal sphincter and positive 'bird beak sign'. On the basis of radiological findings infantile achalasia cardia was diagnosed and patient underwent modified Heller's Oesophagocardiomyotomy with anti reflux procedure. Post operatively the symptoms subsided and weight gain was noted after six month follow up. Although functional infant regurgitation and Gastro-oesophageal reflux (GER) is common in infancy, uncommon causes like achalasia cardia should also be considered as a differential when symptoms are persisting.