Clinical characteristics and treatment outcomes of pediatric achalasia: a 10-year experience from a tertiary center in Iran.

OBJECTIVE: This study aimed to examine demographic patterns, clinical presentation, diagnostic methods, and therapeutic outcomes of achalasia patients in a tertiary hospital in Tehran, Iran. We conducted a retrospective study of patients aged < 18 years with a diagnosis confirmed by barium swallow and endoscopy; those with other diagnoses or incomplete data were excluded. RESULTS: We included 100 patients (59 boys, 41 girls; mean age: 7.45 ± 4.58 years, range: 4 months - 16 years) diagnosed between 2013 and 2022. The most common symptoms were dysphagia (83%), nausea/vomiting (78%), and weight loss (49%). The mean diagnostic delay was 22.04 ± 32.75 months. Comorbid conditions were present in 23% of the patients, most commonly esophageal atresia and Allgrove syndrome. The classic bird's beak sign was seen in 61% of the barium images. 95% of the patients went through pneumatic dilatation (PD), and a successful response to PD was defined as clinical improvement and resolution of dysphagia. 31.6% of them responded to a single PD session, while 68.4% required multiple PD sessions or Heller myotomy. Younger age was significantly associated with the need for multiple PD sessions (p = 0.001). No major complication was seen.