Brodsky Linda, Carr Michele M
State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York 14222, USA.
Curr Opin Otolaryngol Head Neck Surg. 2006 Dec;14(6):387-92. doi: 10.1097/MOO.0b013e3280106326.
To summarize and contextualize current concepts in the incidence, diagnosis, management and long-term sequelae of extraesophageal reflux disease in children.
Extraesophageal reflux disease is a different disease entity from gastroesophageal reflux disease. The two diseases have a common etiology, refluxate causing mucosal damage, but the extent and location of the damage varies considerably depending on the underlying mucosal characteristics. Extraesophageal reflux disease in children is characterized by a broad set of symptoms and signs that vary according to age at presentation and severity of disease. Serious long-term effects begin in childhood. The role of pepsin, bile acids, pancreatic enzymes, motility disorders, and food allergies have only recently been recognized. Newer diagnostic modalities include multichannel intraluminal pH/impedance, the 48 h Bravo implantable probe, and hypopharyngeal pH monitoring. While proton pump inhibitors provide superior acid suppression compared with histamine-2 blockers, variability in response and lack of efficacy for alkaline refluxate often require other therapeutic interventions.
Pediatric extraesophageal reflux disease has variable presentation and a gold standard test is still lacking. Primary treatment includes lifestyle and feeding changes and medical therapy. Ongoing monitoring for recurrence and agreement as to duration of therapy present significant challenges not yet standardized amongst practitioners.
总结并梳理儿童食管外反流病在发病率、诊断、管理及长期后遗症方面的当前概念，并将其置于相应背景中。
食管外反流病与胃食管反流病是不同的疾病实体。这两种疾病有共同的病因，即反流物导致黏膜损伤，但损伤的程度和位置因潜在的黏膜特征不同而有很大差异。儿童食管外反流病的特点是有一系列广泛的症状和体征，这些症状和体征会因发病年龄和疾病严重程度而有所不同。严重的长期影响始于儿童期。胃蛋白酶、胆汁酸、胰酶、动力障碍和食物过敏的作用直到最近才被认识到。新的诊断方法包括多通道腔内pH/阻抗监测、48小时Bravo可植入探头以及下咽pH监测。虽然质子泵抑制剂与组胺-2受体阻滞剂相比能提供更好的抑酸效果，但反应的变异性以及对碱性反流物缺乏疗效常常需要其他治疗干预措施。
儿童食管外反流病表现多样，目前仍缺乏金标准检测方法。主要治疗方法包括生活方式和喂养方式的改变以及药物治疗。对复发的持续监测以及关于治疗持续时间的共识，给从业者带来了重大挑战，目前尚未标准化。
