Achalasia in Children: Diagnosis and Treatment

How do doctors diagnose achalasia?

There are several different tests that doctors can use to diagnose achalasia. Your child might need more than one test to confirm their diagnosis.

X-ray for achalasia

Your child will likely be given a chest x-ray so the doctor can examine the esophagus. The doctor might also give your child a fluid called barium to swallow before the x-ray. The barium will make the esophagus, stomach, and other organs more visible in the x-ray.

Manometry for achalasia

Doctors often use a test called esophageal manometry to diagnose achalasia in children. A special thin tube will be placed into your child’s nose and threaded down the esophagus and into the stomach. The tube checks the pressure inside your child’s esophagus and LES. Children with achalasia have abnormal pressure measurements.

Endoscopy

Sometimes a doctor might want to use a tool called an endoscope look around inside your child’s esophagus. The endoscope is a thin tube attached to a small camera that the doctor will insert into your child’s mouth. The doctor will use the camera to look for what may be causing your child’s symptoms.

How is achalasia treated in children?

Most cases of achalasia will require surgery to help your child swallow and ease other symptoms. In most cases, surgery can help manage symptoms, but it cannot cure achalasia completely.

The most common treatment for achalasia in children is a surgery called the Heller myotomy. This procedure helps expand the LES to make swallowing easier. The surgery is done under general anesthesia laparoscopically (when a camera is inserted through small incisions in the skin). During this surgery, the doctor might also do a fundoplication (when the doctor moves the upper part of the stomach around the bottom of the esophagus). Fundoplication helps ease acid reflux.

What is the outlook for my child with achalasia?

While there is no cure for achalasia, surgery does an excellent job of improving symptoms in most children. 

After surgery, your child will need occasional follow-up appointments to check on their symptoms. Some children might still have mild acid reflux after their operation. In rare cases, your child might need a second surgery if their symptoms worsen or come back.