Key Takeaways

  • Children with achalasia have difficulty swallowing food.
  • The disease occurs because of damage to the nerves and muscles in your child’s esophagus (the tube that connects the mouth and stomach).
  • Surgery can relieve many of your child’s symptoms, but there is no known cure for achalasia right now.
  • Children with achalasia will need check-ups with their doctor even after surgery.

What is achalasia?

Achalasia is a condition that makes it difficult to swallow food. It is caused by a problem with the nerves in the esophagus (the muscular tube where food travels from the mouth to the stomach). In children with achalasia, the muscles that squeeze food down the esophagus do not work properly because of damage to the nerves that control them. Without treatment, the condition can get worse over time. 

Most children with achalasia have a problem with the muscles in the lower esophageal sphincter (LES). The LES opens and closes to allow food from the esophagus to pass into the stomach. In children with achalasia, the LES does not open properly, causing food to get stuck in the lower esophagus.

What causes achalasia?

Doctors are still learning what causes achalasia. In most cases, achalasia happens at random and is not hereditary (passed down in families).

What are the symptoms of achalasia?

The main symptom of achalasia in children is struggling to swallow food or feeling like there is food stuck in the throat. Achalasia can also cause the following symptoms:

  • Vomiting, especially after meals. This happens when too much food builds up in the esophagus.
  • Chest pain
  • Acid reflux (heart burn)
  • Weight loss
  • A cough that doesn’t go away 

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 in children will need surgery to help them 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. In this procedure, the doctor will divide the muscles of the LES to expand the passageway and make swallowing easier for your child. The surgery is done under general anesthesia laparoscopically, with a camera inserted through small incisions in the skin to help the doctor see inside the body. During the surgery, the doctor might also perform a fundoplication, when the upper part of the stomach is moved 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.