Diagnosis and Management of Achalasia in Children, BSPGHAN and BAPS Consensus Statement.
Mohamed Mutalib, Anna Rybak, Iain Yardley et al.
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In 30 seconds
This consensus statement addresses diagnosis and management of achalasia in children, for whom pediatric-specific guidelines were lacking. An expert panel from BSPGHAN and BAPS used a modified Delphi process, informed by a systematic review of 121 pediatric studies, to develop recommendations across diagnosis, treatment, follow-up, transition to adult care, and research. The panel reached agreement (> 80%) on 21 recommendations. High-resolution manometry was identified as the primary diagnostic investigation, and peroral endoscopic myotomy and laparoscopic Heller’s myotomy were recommended as first-line definitive treatments.
Key findings
- The systematic review included 121 pediatric studies, which the authors characterized as low-quality evidence.
- The expert panel reached > 80% agreement on 21 consensus recommendations.
- High-resolution manometry is recommended as the primary diagnostic investigation, with timed barium oesophagogram and endoscopy as complementary tests.
- Peroral endoscopic myotomy and laparoscopic Heller’s myotomy are recommended as first-line definitive treatments, with selection guided by subtype, center expertise, and family preference.
Why it matters
The statement provides a pediatric-specific framework for a disorder previously lacking dedicated clinical guidelines. Its recommendations address diagnostic testing and definitive treatment as well as transition to adult services and long-term surveillance, supporting more consistent care while identifying the need for stronger evidence and collaborative research.
What to keep in mind
The recommendations draw on a systematic review in which the 121 pediatric studies were judged to provide low-quality evidence.