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Updated: Jan 22, 2026
Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
Management and outcomes of paediatric achalasia: multicentre retrospective study in the UK
Jonathan J Neville1, Esther Westwood2, Amanda Ladell3
1Great Ormond Street Institute of Child Health, University College London, London, UK.
Insights
Heller's cardiomyotomy (HCM) offered higher success rates for achalasia in children and young people (CYP) compared to endoscopic balloon dilatation (EBD). However, many CYP remained symptomatic post-treatment, indicating a need for improved management strategies.
Area of Science:
- Pediatric Gastroenterology
- Rare Disease Research
- Surgical Outcomes
Background:
- Achalasia is a rare esophageal motility disorder in children and young people (CYP).
- Current management strategies lack consensus, leading to varied treatment approaches.
- Significant symptoms and need for invasive interventions impact CYP quality of life.
Purpose of the Study:
- To investigate current management practices and treatment outcomes for achalasia in CYP in the UK.
- To compare the effectiveness and complication rates of different first-line interventions.
- To identify factors influencing treatment success and long-term symptom burden.
Main Methods:
- Retrospective analysis of 126 CYP (≤16 years) diagnosed with achalasia between 2011-2021 in the UK.
- Data collected from patient records, co-designed with patient advocacy group Achalasia Action.
- Primary outcome: treatment success; secondary outcomes: complication rates and 1-year symptom status.
Main Results:
- Heller's cardiomyotomy (HCM) demonstrated a higher success rate (72%) than endoscopic balloon dilatation (EBD) (6%) for first-line treatment (P < 0.001).
- HCM had a higher complication rate (17%) compared to EBD (5%) (P = 0.045).
- Overall treatment success after first-line intervention was 45.8%, with 53% of patients symptomatic at 1-year follow-up.
Conclusions:
- Significant variation exists in achalasia management for CYP across UK centers.
- HCM is associated with the highest treatment success rates but also more complications.
- Many CYP experience persistent symptoms, necessitating further interventions and improved management guidelines.
Background:
Achalasia is rare disease in children and young people (CYP) that causes significant symptoms and often requires invasive interventions. There is currently no consensus on the optimal management strategy. This study investigated the current management and outcomes of CYP with achalasia in the UK.
Methods:
A retrospective study was conducted of CYP (aged ≤ 16 years) diagnosed with achalasia between 2011 and 2021 in the UK. The study was co-designed with the patient group Achalasia Action. Data were collected from patient records. The primary outcome was treatment success.
Results:
In all, 126 patients were included from 13 UK centres; 64 of the patients (50.8%) were male and the median age at diagnosis was 12 (interquartile range (i.q.r.) 9-14) years. The most frequent presenting features were dysphagia (73.8%), vomiting (53.2%), and weight loss (38.9%). The median time from symptom onset to diagnosis was 11 (i.q.r. 6-24) months. Treatment success was achieved in 55 of 120 patients (45.8%) after first-line intervention. Heller's cardiomyotomy (HCM) as the first-line intervention had a higher success rate than endoscopic balloon dilatation (EBD; (52 of 72 (72%) versus 3 of 48 (6%), respectively; P < 0.001). However, overall HCM had a higher frequency of complications than EBD (17 of 98 (17%) versus 3 of 57 (5%), respectively; P = 0.045). In the entire cohort, 53% of patients reported symptoms at the 1-year follow-up.
Conclusions:
Variation exists in the management of CYP with achalasia in the UK. The highest rates of treatment success were associated with HCM. Many CYP remain symptomatic after treatment and require multiple interventions. The present data can be used to inform management decisions in CYP with achalasia.
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