Chalasia is a condition most commonly identified in infants and young children, and is related to congenital incompetence of the lower oesophageal sphincter, allowing unrestricted reflux of gastric contents. This contrasts with achalasia, where there is restriction at the gastro-oesphageal junction limiting oesophagal emptying.
Chalasia is suspected in children of several months of age that present with frequent and persistent regurgitation after feeding, and when placed in a horizontal position.
As infants mature and gain better neuromuscular control and coordination, normally sphincter tone gradually increases reducing regurgitation. Persistence of reflux and vomiting after several months of age is abnormal and chalasia becomes a concern.
Affected children are typically unremarkable aside from the symptoms related to chalasia, but may have a familial predisposition, or may have a predisposing neurological impairment with chalasia as a complication.
Reflux esophagitis may lead to pain, blood loss, and oesophageal strictures. As the condition persists, continued vomiting may lead to growth failure, anaemia, respiratory complications, and rarely sudden infant death syndrome.