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Oesophageal achalasia is a rare gastrointestinal motility disorder of increasing incidence with no gender or racial predilection. It affects around 27.1 in 100,000 people in England and 10.82 in 100,000 globally and is rarer still in the paediatric population with an estimated incidence of 0.38/100,000 children per year. 1 2 Achalasia causes ineffective oesophageal peristalsis and impaired lower oesophageal sphincter relaxation giving rise to the typical symptoms of regurgitation, dysphagia, retrosternal chest pain and weight loss.3 In paediatric patients, food refusal and failure to thrive are commonly reported.4 The gold standard for diagnosis remains high resolution oesophageal manometry but diagnosis can be delayed due to the rare incidence combined with the overlap of symptoms and heterogenous clinical assessment tools.Though relatively uncommon, achalasia is known to significantly impact health related quality of life (QOL). There is no curative treatment, but symptom amelioration can be achieved using interventions such as pneumatic balloon dilatation, laparoscopic Hellers myotomy and per-oral endoscopic myotomy.4 Symptom improvement can positively impact QOL, however in patients for whom symptoms persist, mental wellbeing is poorer compared with the general population and may progressively worsen over time.5 Despite the recognition of the impact, there is no universally agreed disease-specific approach for evaluation of QOL of patients with achalasia. Additionally, evaluation of pre and post-intervention symptom profiles is inconsistent, further limiting the ability to understand the effectiveness of interventions.We conducted a systematic literature review of existing research on quality of life in achalasia patients. Ovid was used to search multiple digital databases: Journals@Ovid Full Text Subset, Journals@Ovid, Ovid Medline (1946–2024), Embase (1974–2024), Ovid Emcare (1995 to 2024), HMIC Health Management Information Consortium (1979 to 2024).Initial literature search produced 1746 articles and following removal of duplicate articles and title screening 95 articles remained. Abstracts screening reduced this further to 69 and after full text review the resulting number of articles was forty-nine.Predominantly these studies involved adult patient cohorts with only two articles (4%) evaluating children. The patient cohort sizes were variable with an average of fifty-four patients (range 8 – 201). Figure 1 demonstrates the significant heterogenicity of the QOL tools used, and despite the existence of disease-specific assessment tools (for example the Achalasia-Specific Quality-Of-Life-Questionnaire, ASQ) these do not appear to be widely implemented, suggesting either a lack of clinician awareness that these tools exist, or that the tools themselves are not fulfilling the clinical need.Abstract OC68 Figure 1QOL assessment toolsConsidering the rarity of achalasia as a condition, this unstandardised approach significantly impacts the ability to draw meaningful conclusions about the impact of interventions on QOL. Furthermore, many studies did not use Ecktardt Score when evaluating the clinical symptoms, thus reiterating the lack of standardisation. Many do not include both pre and post intervention assessments, further adding to the deficit in understanding the clinical significance of intervention. To improve understanding of impact on QOL and thus outcomes for patients there is a need to develop a standardised QOL score to assess patients with achalasia before and after intervention.References Harvey PR, et al. Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data. Gut. 2019;68(5):790–795. https://doi.org/10.1136/gutjnl-2018-316089 Smits M, et al. Paediatric achalasia in the Netherlands: incidence, clinical course, and quality of life. J Pediatr. 2016;169:110–5. http://dx.doi.org/10.1016/j.jpeds.2015.10.057 Rieder E, et al. Achalasia: physiology and diagnosis. Annals of the New York Academy of Sciences 2020;1482(1):85–94. https://doi.org/10.1111/nyas.14510 Savarino E, et al. Achalasia. Nature Reviews Disease Primers 2022;8(1):28. https://doi.org/10.1038/s41572-022-00356-8 Hanschmidt F, et al. Psychological burden of achalasia: patients’ screening rates of depression and anxiety and sex differences. PLOS ONE. 2023;18(5):e0285684. https://doi.org/10.1371/journal.pone.0285684