Treatment of Idiopathic Achalasia in the Pediatric Population: A Systematic Review.

BACKGROUND: Achalasia is a rare idiopathic neuromuscular disorder of the esophagus, characterized as a syndrome of impaired relaxation of the lower esophageal sphincter and decreased peristalsis of the esophageal body. OBJECTIVE: The primary objective is to determine the best first-line treatment for pediatric achalasia based on the consolidation of the current literature that compares outcomes after pneumatic dilatation (PD) versus surgical myotomy (Heller esophagomyotomy [HM]). DATA SOURCES: A systematic review of English articles using OVID was performed. STUDY SELECTION: OVID was used to search for articles focusing on the treatment of pediatric esophageal achalasia with PD versus HM. DATA EXTRACTION: Independent extraction of data was performed by N.E.S using predefined data fields. DATA SYNTHESIS: Seven articles were included in the systematic review. Techniques of HM and PD varied widely. The best first-line treatment of pediatric achalasia was determined to be HM in two articles, PD in one article, and equal efficacy in one article. Three articles concluded that appropriate initial treatment was determined by the age of the child. CONCLUSION: Adequate comparative data are lacking to determine the ideal treatment of pediatric achalasia. Appropriately designed randomized controlled trials with long-term follow-up are needed to determine ideal treatment algorithms in pediatric achalasia.