Clinical Management of Pediatric Achalasia: A Survey of Current Practice

Area of Science:

• Pediatric Gastroenterology
• Neurodegenerative Esophageal Disorders
• Clinical Practice Management

Background:

• Pediatric achalasia is a rare neurodegenerative esophageal disorder requiring effective treatment.
• Current diagnostic and therapeutic strategies for pediatric achalasia lack comprehensive data for optimal care.
• Understanding current management practices is crucial for improving patient outcomes.

Purpose of the Study:

• To identify and analyze current diagnostic and therapeutic practices for pediatric achalasia.
• To assess the heterogeneity in the management of pediatric achalasia across different healthcare centers.
• To establish a baseline for future intervention trials in pediatric achalasia care.

Main Methods:

• An online survey was distributed to members of the European and North American Societies for Pediatric Gastroenterology Hepatology and Nutrition.
• The survey collected data on diagnostic and treatment approaches for pediatric achalasia from 38 centers in 24 countries.
• Data included diagnostic methods, multidisciplinary team involvement, and primary treatment modalities.

Main Results:

• A total of 108 children were diagnosed with achalasia in the surveyed centers within the last year.
• Pediatric gastroenterologists managed most cases, with multidisciplinary teams involved in 84% of centers.
• Heller myotomy was the most frequent first-choice treatment (58%), followed by pneumatic dilation (46%) and peroral endoscopic myotomy (29%).

Conclusions:

• Significant heterogeneity exists in the global management of pediatric achalasia.
• The findings underscore the urgent need for well-designed clinical trials to establish evidence-based guidelines.
• Centralized care in specialized centers with advanced diagnostic and treatment capabilities is recommended for pediatric achalasia.