Diagnostic challenges and therapeutic outcomes in pediatric achalasia: insights from a retrospective study at a tertiary care center

Achalasia is a primary esophageal motility disorder that impairs the relaxation of the lower esophageal sphincter. Objective. To evaluate the diagnostic and therapeutic approaches to the treatment of achalasia in children at Namazi Hospital, to assess the efficacy of different treatment modalities used at the center, and to explore whether there is a need to introduce peroral endoscopic myotomy (POEM) in pediatric practice. Patients and methods. This retrospective cross-sectional study included children diagnosed with achalasia between 2016 and 2023 at Namazi Hospital. Patients were selected from the hospital’s archives using the ICD-10 code (K22.0). Data on demographic characteristics, diagnostic findings, and therapeutic interventions were collected. Results. A total of 41 patients were included in the study, with a mean age of 7.17 (±5.41) years at the initial presentation. Among these patients, 36.6% were female and 63.4% were male. Significant differences were observed in the age of onset between children with and without failure to thrive (FTT) (p = 0.006). However, there were no significant differences in the duration of the disease prior to diagnosis (p = 0.839) or in the change in Eckardt score (p = 0.095). The Wilcoxon signed-rank test showed a significant reduction in Eckardt scores following an intervention, with a Z-value of -5.53 and a p-value of less than 0.001. The Mann–Whitney U test indicated no significant difference in Eckardt scores before the intervention between both genders (p = 0.524). Conclusion. The study revealed that earlier onset of achalasia is associated with FTT, and interventions significantly reduce Eckardt scores. No significant gender differences were observed in Eckardt scores prior to treatment. Further research with a larger sample and a longitudinal approach is recommended to expand these findings. Key words: achalasia, Heller myotomy, Eckardt score, pediatrics