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.