Paeds · gastroenterology-hepatology-and-nutrition
Dysphagia and oesophageal disorders
Also known as Dysphagia · Swallowing difficulty · Oropharyngeal dysphagia · Oesophageal dysphagia · Odynophagia · Eosinophilic oesophagitis · EoE · Achalasia · Oesophageal dysmotility · Oesophageal stricture · Food bolus impaction · Feeding difficulty
Fellowship guide to dysphagia and the oesophageal disorders of childhood: the child who cannot move food safely from mouth to stomach, whether because the transfer of the bolus from the pharynx fails or because its transport down the oesophagus is blocked or uncoordinated. The page separates oropharyngeal from oesophageal dysphagia and structural from motility disease, and works through the two examined oesophageal conditions in depth — eosinophilic oesophagitis, the Th2 allergic disease that scars the oesophagus and impacts food, and achalasia, the loss of inhibitory myenteric neurons that leaves the lower oesophageal sphincter unable to relax. It covers gastro-oesophageal reflux, oesophageal atresia and its dysmotility, caustic and peptic strictures, and the emergencies of button battery and food bolus impaction, then the investigations (videofluoroscopy, endoscopy with biopsy, high-resolution manometry, pH-impedance) and the layered management from proton pump inhibitors and swallowed steroids through dupilumab, pneumatic dilation, Heller myotomy and peroral endoscopic myotomy.
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- A disc (button) battery lodged in the oesophagus is a time-critical emergency: it causes liquefactive burns within two hours and needs removal within six, so any child with a witnessed or suspected battery ingestion and drooling, chest pain or refusal to feed goes straight to imaging and endoscopy, not to observation
- A child who suddenly cannot swallow their own saliva, is drooling and distressed after a meal has a food bolus impaction until proven otherwise and needs urgent endoscopy, and impaction in a child is eosinophilic oesophagitis until the biopsy says otherwise
- Progressive dysphagia to solids then liquids with weight loss and regurgitation of undigested food points to achalasia or a stricture and mandates barium swallow, endoscopy and manometry rather than reassurance
- Odynophagia, drooling and refusal to drink in the hours to days after a caustic ingestion signal oesophageal injury and possible perforation — do not induce vomiting, do not blind-pass a tube, and involve surgery and endoscopy early
- Dysphagia with new neurological signs, a hoarse or wet voice, recurrent chest infections or coughing and choking with feeds signals unsafe swallowing and aspiration, and the child should be kept nil by mouth until a swallow assessment confirms safety
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- Normal swallowing and oesophageal physiology in children
- Approach to the child with dysphagia and feeding difficulty
- Gastro-oesophageal reflux and its complications
- Eosinophilic oesophagitis: diagnosis and management
- Paediatric achalasia and oesophageal motility disorders
- Oesophageal atresia, strictures and ingestion injury
- The child with dysphagia or food bolus impaction
- Investigation of oesophageal disease: endoscopy, manometry and pH-impedance
- Long-term management of eosinophilic oesophagitis and achalasia
- Long case: the child with eosinophilic oesophagitis and its nutritional and quality-of-life impact
- Short case: assessment of the child with feeding difficulty and dysphagia
- Gastroenterology: dysphagia and oesophageal disorders
- The child who chokes, refuses food or fails to thrive
- Eosinophilic oesophagitis and achalasia
- Dysphagia, reflux and oesophageal emergencies
- Assessment of the child with dysphagia and feeding difficulty
- Dysphagia and oesophageal disorders
- Eosinophilic esophagitis
- Gastroesophageal reflux disease
- Medical Knowledge: dysphagia and disorders of the oesophagus
- Medical Expert: dysphagia and oesophageal disorders
Overview & Definition
A toddler coughs and turns blue at every meal and is losing weight; a school-aged boy has quietly learned to eat slowly, chew endlessly and wash each mouthful down with water; a teenager arrives drooling and retching, unable to swallow the steak that is stuck in his chest. All three have dysphagia, but the problem sits in three different places, and telling them apart is the whole task. Dysphagia is difficulty moving food and fluid safely from the mouth to the stomach, and in children it is as much a nutritional and airway problem as a gastrointestinal one. [9] [14]
The swallow has two mechanical stages, and dysphagia is first sorted by which one fails. Oropharyngeal (transfer) dysphagia is trouble getting the bolus out of the mouth and pharynx and safely past the airway, and it dominates in children with neurological and neuromuscular disease. Oesophageal (transport) dysphagia is trouble moving the bolus down the oesophagus, and it points to a structural block or a motility disorder of the oesophageal body and its sphincters. [14] [5]
This page owns the oesophageal side in depth and treats the two examined conditions — eosinophilic oesophagitis and achalasia — as the anchors. Around them sit gastro-oesophageal reflux, oesophageal atresia and its dysmotility, peptic and caustic strictures, and the two emergencies every candidate must recognise instantly, the button battery and the food bolus impaction. The oropharyngeal side is covered as the essential first fork and for its overlap with neurodisability, then linked to feeding and aspiration assessment. [1] [5]
References16ShowHide
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- [2]Dellon ES; Liacouras CA; Molina-Infante J; et al Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology, 2018.PMID 30009819
- [3]Dellon ES; Muir AB; Katzka DA; et al ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. Am J Gastroenterol, 2025.PMID 39745304
- [4]Dellon ES; Rothenberg ME; Collins MH; et al Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med, 2022.PMID 36546624
- [5]Franklin AL; Petrosyan M; Kane TD Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management. World J Gastrointest Endosc, 2014.PMID 24748917
- [6]Khashab MA; Vela MF; Thosani N; et al ASGE guideline on the management of achalasia. Gastrointest Endosc, 2020.PMID 31839408
- [7]Zhong C; Tan S; Huang S; et al Clinical outcomes of peroral endoscopic myotomy for achalasia in children: a systematic review and meta-analysis. Dis Esophagus, 2021.PMID 33316041
- [8]Mencin AA; Kramer RE; Bortolin K; et al Peroral Endoscopic Myotomy (POEM) in Children: A State of the Art Review. J Pediatr Gastroenterol Nutr, 2022.PMID 35653433
- [9]Rosen R; Vandenplas Y; Singendonk M; et al Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr, 2018.PMID 29470322
- [10]Ebbott D; Meisner J; Rentea RM; et al Long-Term Aerodigestive Morbidities After Esophageal Atresia/Tracheoesophageal Fistula Repair. J Pediatr Surg, 2025.PMID 40441419
- [11]Bashir A; Sharma N; Rao S; et al Esophagitis, treatment outcomes, and long-term follow-up in children with esophageal atresia. J Pediatr Gastroenterol Nutr, 2024.PMID 39415542
- [12]Arnold M; Numanoglu A Caustic ingestion in children-A review. Semin Pediatr Surg, 2017.PMID 28550877
- [13]Mubarak A; Benninga MA; Broekaert I; et al Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper. J Pediatr Gastroenterol Nutr, 2021.PMID 33555169
- [14]Calderone A; Latella D; Cardile D; et al Swallowing disorders in cerebral palsy: a systematic review of oropharyngeal Dysphagia, nutritional impact, and health risks. Ital J Pediatr, 2025.PMID 39985076
- [15]Yadlapati R; Kahrilas PJ; Fox MR; et al Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0(©). Neurogastroenterol Motil, 2021.PMID 33373111
- [16]Esparaz JR; Jeziorczak PM; Mowrer AR; et al Esophageal Foreign Body Management in Children: Can It Wait? J Laparoendosc Adv Surg Tech A, 2020.PMID 33121359