Paediatric Eckardt Symptom Score is an effective tool to assess childhood achalasia

Objectives Achalasia is a rare oesophageal motility disorder with rising incidence in children. The Eckardt Symptom Score (ESS) is a simple tool to assess symptom severity with good correlation to quality of life (QoL). It is not validated in children and there is no comparable scoring system for paediatric achalasia. In our institution, we have implemented a modified ESS to better capture children’s symptoms. We aimed to share the outcome of using the paediatric ESS (PESS) in relation to QoL preintervention and postintervention in children with achalasia. Methods All children diagnosed with achalasia in Evelina London Children’s Hospital in London, in whom the final iteration of this PESS was used between March 2022 and January 2025, were included. Symptoms were assessed at diagnosis and 4–6 weeks after each intervention. Results Sixty-seven paired Achalasia Specific Questionnaire (ASQ) Scores and PESS from 13 children (median age 12 years (IQR 9–15)) were included. Four children underwent laparoscopic Heller myotomy (31%) and nine underwent pneumatic dilatation (PD). The whole cohort, preintervention and postintervention, showed a moderate to strong positive correlation (r=0.686, p< 0.001) between PESS and ASQ Scores. Preintervention showed a moderate to strong positive correlation (r=0.717, p<0.001) and postintervention also showed a moderate to strong positive correlation (r=0.661, p < 0.001). All individual PESS items were either strongly or moderately correlated to ASQ. Conclusion PESS can accurately assess preintervention and postintervention symptoms in children with achalasia. It has a strong correlation with QoL, and all PESS components contributed to the validity of the score.