Clinical management of pediatric achalasia

ABSTRACT

Introduction

Achalasia is a rare esophageal motility disorder. Much of the literature is based on the adult population. In adults, guidance of therapeutic approach by manometric findings has led to improvement in patient outcome. Promising results have been achieved with novel therapies such as PerOral Endoscopic Myotomy (POEM).

Areas covered

In this review, we provide an overview of the novel diagnostic and therapeutic tools for achalasia management and in what way they will relate to the future management of pediatric achalasia. We performed a PubMed and EMBASE search of English literature on achalasia using the keywords ‘children’, ‘achalasia’, ‘pneumatic dilation’, ‘myotomy’ and ‘POEM’.

Cohort studies < 10 cases and studies describing patients ≥ 20 years were excluded. Data regarding patient characteristics, treatment outcome and adverse events were extracted and presented descriptively, or pooled when possible.

Expert commentary

Available data report that pneumatic dilation and laparoscopic Heller’s myotomy are effective in children, with certain studies suggesting lower success rates in pneumatic dilation. POEM is increasingly used in the pediatric setting with promising short-term results. Gastro-esophageal reflux disease (GERD) may occur post-achalasia intervention due to disruption of the LES and therefore requires diligent follow-up, especially in children treated with POEM.

KEYWORDS:

• Achalasia
• children
• esophageal high-resolution manometry
• pneumatic dilation
• myotomy
• PerOral Endoscopic Myotomy

Acknowledgments

The authors would like to acknowledge F. van Etten-Jamuladin (Medical Library, Academic Medical Center, Amsterdam, Netherlands) for performing a PubMed and EMBASE search.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This article was not funded.