title: Diagnosis, misdiagnosis, and associated diseases of achalasia in children and adolescents: a twelve-year single center experience.
abstract: OBJECTIVE
  Although achalasia is a rare disorder in children, its symptom may mimic common childhood diseases. This study aimed to assess the diagnosis and management of achalasia in children and adolescents in a Brazilian single center during a 12-year period.
  
  
  METHODS
  Patients with achalasia were identified from a database built during the period of January 2000-January 2012 from a Pediatric Gastroenterology reference center. Information regarding demographic data, clinical symptoms, diagnosis, treatment, and long-term follow-up were described.
  
  
  RESULTS
  Thirteen patients were studied; median age was 7 (1-14) years. Most frequent symptoms were vomiting (84.6 %) and dysphagia (69.2 %). Weight loss occurred in 46.0 % of patients and chronic cough in 46.1 %. Associated disorders were Down's syndrome, Allgrove syndrome, and congenital central hypoventilation syndrome. Achalasia was misdiagnosed with anorexia nervosa. Six patients were previously treated as having gastroesophageal reflux disease and asthma. Five patients had pneumatic balloon dilation as initial therapy whereas five had esophageal myotomy. Finally, 11 patients had surgical therapy with a favorable follow-up.
  
  
  CONCLUSIONS
  Achalasia symptoms may mimic common diseases in children, and therefore, may delay the diagnosis. This study emphasizes the importance of the clinical symptoms for the diagnosis of achalasia, mainly in those cases with associated disorders.
authors.affiliation: Post-Graduate Program Sciences in Gastroenterology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. cris.hallal@yahoo.com
authors.forename: Cristiane
authors.initials: C
authors.lastname: Hallal
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Kieling
authors.forename: Daltro L
authors.initials: DL
authors.lastname: Nunes
authors.forename: Cristina T
authors.initials: CT
authors.lastname: Ferreira
authors.forename: Guilherme
authors.initials: G
authors.lastname: Peterson
authors.forename: Sérgio G S
authors.initials: SG
authors.lastname: Barros
authors.forename: Cristina A
authors.initials: CA
authors.lastname: Arruda
authors.forename: José C
authors.initials: JC
authors.lastname: Fraga
authors.forename: Helena A S
authors.initials: HA
authors.lastname: Goldani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D004931:Esophageal Achalasia / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors