It seems most children will have difficulty swallowing at one point in their life, but for a few the problem can be persistent. When swallowing troubles persist, it can be a sign of something more serious, especially if the child vomits food that looks barely digested, has chest pain, or if they are not growing well. This often points to a problem with the esophagus (the tube that carries food from the mouth to the stomach) and could be caused by achalasia.
What Is Achalasia?
Achalasia is a rare disorder where the esophagus does not squeeze food down to the stomach properly. And when it does, the sphincter at the bottom of the esophagus does not open, preventing the food from entering the stomach. As a result, someone with achalasia will have a hard time swallowing, eat very slowly, and could even lose weight as they cannot eat enough food. Food may stay in the esophagus longer than it should, sometimes more than a day.
While achalasia can occur in children at any age, it is more common in adults.
Common achalasia symptoms are:
Trouble swallowing – worse with solid food, and may progress to liquids
Throwing up (vomiting) food that the body hasn’t broken down yet (undigested)
Regurgitation – swallowed food or liquid comes back up into the mouth
Not gaining weight
Coughing a lot when lying down
Fluid sloshing in chest while moving
How Is Achalasia Diagnosed?
Your child may have achalasia if their symptoms have lasted for at least a few weeks and are getting worse. To diagnose achalasia, your child’s health care provider will examine the esophagus and order special tests to take pictures and measure pressures inside the esophagus while they’re swallowing.
How Is Achalasia Treated?
Achalasia continues to worsen with time. Severe cases may require a full liquid diet, either to drink or give through a feeding tube. Unfortunately, medications do not help. Procedures and surgeries aim to make the tight sphincter at the bottom of the esophagus more open, to let food pass into the stomach. This may be done with multiple dilations using very large balloons, or with invasive surgeries.
Today, a less invasive endoscopic procedure is used, called Per Oral Endoscopic Myotomy (or POEM for short). POEM creates a small incision in the lining of the esophagus, allowing the endoscope camera to safely travel underneath the lining of the esophagus, down to the bottom of the esophagus to then cut the tight sphincter. A few tiny clips are used to close the small incision.
POEM is safer and less invasive than surgery, and has better results than dilation, allowing patients to quickly return to eating more normal again. Most patients will spend just one night in the hospital afterward and are eating regular food again in one week! Read more about the POEM procedure at Nationwide Children’s Hospital.
The treatments for achalasia today make this condition much easier to swallow!
Muhammad Khan, MD, MPH, FASGE, is a Pediatric Interventional Endoscopist, with more than 10 years of experience as a Pediatric Gastroenterologist. He has a special focus in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in the diagnostic evaluation and therapeutic management of chronic pancreatitis, peri-pancreatic fluid collections, and other hepatopancreaticobiliary disorders.
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