[Therapeutic dilemmas in children with esophageal achalasia]

Two patients with oesophageal achalasia are presented. The first patient, a 22-month-old girl, had medical, endoscopic and surgical treatment. The effectiveness of drug therapy with nifedipine was good but short in duration. Endoscopic bougienage dilatation has not been definitely successful. Operative treatment, two years after the first symptoms, permanently resolved the problem of spastic lower oesophageal sphincter. The second girl, 13.5 years old, responded very well to nifedipine therapy during hospitalisation. Because of inadequate drug usage, oesophageal myotomy was performed relatively soon. In follow-up both girls were in good health condition. The treatment of oesophageal achalasia in children is still controversial. Therapeutic approach and decision on the treatment strategy depend primarily on patient's age, duration and severity of clinical signs and symptoms Etiology, pathogenesis, and possibilities of achalasia treatment are discussed.