Pyun Jung Eun, Choi Da Min, Lee Jung Hwa, Yoo Kee Hwan, Shim Jung Ok
Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
Pediatr Gastroenterol Hepatol Nutr. 2015 Mar;18(1):55-9. doi: 10.5223/pghn.2015.18.1.55. Epub 2015 Mar 30.
Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.
胃食管反流病（GERD）是儿童中最常见的食管疾病。贲门失弛缓症较少见，但症状与GERD相似。一名9岁男孩出现呕吐、烧心和夜间咳嗽。食管阻抗-pH监测显示为非酸性GERD（所有反流物清除时间百分比为20.9%）。尽管接受了GERD的药物治疗，他的症状仍持续存在，随后失访。四年后，他出现烧心、固体食物吞咽困难、每日餐后呕吐和生长发育迟缓。内镜检查显示食管严重扩张并伴有念珠菌感染。进行了高分辨率测压，诊断为典型贲门失弛缓症（也称为I型）。经过两次气囊扩张手术后，他的症状得到缓解，体重和身高开始赶上同龄人。即使在进行了阻抗-pH监测评估后，临床医生也可能会考虑对非典型GERD儿童使用高分辨率测压。
