Diamanti A, Noto C, Magistrelli A, Perotti G, Panetta F, Diomedi-Camassei F, Inserra A
Department of Hepatology, Gastroenterology and Nutrition, Bambino Gesù Pediatric Hospital, Rome, Italy.
Thorac Cardiovasc Surg. 2011 Apr;59(3):186-8. doi: 10.1055/s-0030-1250427. Epub 2011 Apr 8.
Children with neurological disorders may suffer from gastroesophageal reflux disease (GERD). Typical symptoms are vomiting, regurgitation and hematemesis. Patients present with respiratory symptoms only in cases with swallowing disorders causing chronic airway aspiration. We report the case of a patient affected by chromosome 8 p deletion syndrome with mental retardation, referred to our unit for suspected GERD. Chest X-ray, performed at admission for coexisting respiratory complaints, showed left lower lobe pneumonia; esophageal pH monitoring and upper endoscopy were normal for GERD. To rule out chronic airway aspiration, gastroesophageal 99 mTc scintigraphy with lung scan 18 to 24 h after a test meal and video fluoroscopy swallowing study were performed, both negative. Two months later, a second episode of left lower lobe pneumonia occurred. A chest CT scan was performed and showed an endobronchial mass; the biopsy taken during the broncoscopy was not conclusive. Surgical excision resulted in a diagnosis of pulmonary carcinoid. Bronchial carcinoids, although rare, should be taken into consideration as a potential cause of recurrent pneumonia even in the presence of demonstrated GERD where severe respiratory infections only occur with coexisting chronic pulmonary aspiration, even in neurologically impaired people.
患有神经系统疾病的儿童可能会患胃食管反流病（GERD）。典型症状为呕吐、反流和呕血。仅在因吞咽障碍导致慢性气道误吸的情况下，患者才会出现呼吸道症状。我们报告了一例患有8号染色体短臂缺失综合征并伴有智力障碍的患者，因疑似GERD转诊至我们科室。因同时存在呼吸道症状入院时进行的胸部X线检查显示左下叶肺炎；食管pH监测和上消化道内镜检查未发现GERD异常。为排除慢性气道误吸，在试餐后18至24小时进行了胃食管99mTc闪烁扫描及肺部扫描，并进行了视频荧光吞咽研究，结果均为阴性。两个月后，再次发生左下叶肺炎。进行了胸部CT扫描，显示支气管内有肿块；支气管镜检查时所取活检结果不明确。手术切除后诊断为肺类癌。支气管类癌虽然罕见，但即使在已证实存在GERD的情况下，即使在神经系统受损的人群中，严重呼吸道感染仅在伴有慢性肺误吸时才会发生，也应将其视为复发性肺炎的潜在病因。
