Achalasia in a child confirmed by high-resolution manometry

Achalasia is a primary motor disease of the esophagus. It is rare in the pediatric population; fewer than 5% of patients are below 15 years of age. Progressive dysphagia is the most common presentation in adults. The clinical presentation in children does differ from adults. The various clinical features are nocturnal cough, recurrent pneumonia, vomiting, and feeding difficulties. The symptoms of achalasia may mimic gastroesophageal reflux disease in children. We report a 4-year-old boy presented with increasing difficulty in swallowing. Esophagram showed a smooth narrowing of the distal end and dilated esophagus. High-resolution manometry (HRM) had confirmed the diagnosis by fulfilling the criteria for achalasia Type 2. HRM has high sensitivity than conventional and may predict prognosis. He underwent Heller's myotomy with an anti-reflux procedure. The patient was asymptomatic after curative surgery. We report a rare case of achalasia in a 4-year-old boy confirmed by novel diagnostic technique HRM; hence, pediatric data of HRM are limited.