TY - CHAP M1 - Book, Section TI - Achalasia A1 - Frykman, Philip K. A1 - Azizkhan, Richard G. A2 - Ziegler, Moritz M. A2 - Azizkhan, Richard G. A2 - Allmen, Daniel von A2 - Weber, Thomas R. PY - 2014 T2 - Operative Pediatric Surgery, 2e AB - Esophageal achalasia has profound impact on a child's growth and development with many children presenting with failure to thrive.Symptoms include dysphagia, regurgitation of undigested food, and nocturnal wheezing in older children; and respiratory difficulties such as wheezing, chronic coughing, bronchitis, pneumonitis, and recurrent pneumonia in younger children.Classic radiographic findings of a barium esophagogram are dilated esophagus with a “bird's beak” narrowing of the lower esophageal sphincter (LES).Esophageal manometry is the gold standard study to confirm the diagnosis of achalasia. The hallmark manometric findings are increased LES resting pressure, absence of peristalsis, and failure of LES to relax to swallowing.The primary treatment of choice for children with achalasia is surgical, specifically the modified Heller esophagomyotomy (EM).Either a laparoscopic or thoracoscopic approach can be used with similar success. Currently, the preferred approach is a laparoscopic Heller EM with concomitant fundoplication.Long-term outcomes show around 90% relief of dysphagia with rapid resumption of normal diet and growth with diminution of respiratory symptoms. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1100433234 ER -