Autism and esophageal achalasia in childhood: a possible correlation? Report on three cases


  • The authors report no conflicts of interest.

  • The authors declare that this study was not supported by any grant.

  • Authors' contributions

  • Mario Costantini substantially contributed to the conception and design of the study and approved the final version of the manuscript.

  • Pietro Betalli and Piergiorgio Gamba were involved in drafting the manuscript and critically revising its intellectual content.

  • Elena Carretto and Mara Cananzi contributed to data analysis and interpretation, and critically revised the work.

  • Lisa Zanatta, Renato Salvador, Francesca Galeazzi, and Graziella Guariso made substantial contributions to data acquisition.

  • All authors have read and approved the final manuscript.

Dr Elena Carretto, MD, Division of Pediatric Surgery, Departments of Pediatrics, University of Padua, 3, via Giustiniani, 35128 Padova, Italy. Email:


Chronic gastrointestinal symptoms are commonly reported in autistic patients. Dysphagia is often present, and it is generally related to behavioral eating disorders. The association between autism and esophageal achalasia has not been described in literature yet. We report our experience with three cases of autistic children we recently treated for esophageal achalasia. In the first case (a 14-year-old male), achalasia was diagnosed with barium swallow and esophageal manometry and was successfully treated with three pneumatic endoscopic dilatations (follow-up: 3 years). In the second case (a 12-year-old female), achalasia was diagnosed with barium swallow and esophageal manometry and was treated with Heller myotomy after two unsuccessful pneumatic endoscopic attempts (follow-up: 3 months). In the last case, a 15-year-old male underwent barium swallow and endoscopy that confirmed achalasia. He was treated with Heller myotomy, and he is asymptomatic at a 6-month follow-up. To our knowledge, this is the first report of a possible association between autism and esophageal achalasia. Because of the rarity of both diseases, their association in the same patient is unlikely to be casual even if speculation on their common etiology is impossible at present. This finding needs further confirmation, but it is sufficient, in our opinion, to indicate proper evaluation with barium swallow and/or manometry in any autistic children with eating difficulty.