Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Otolaryngology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Int J Pediatr Otorhinolaryngol. 2020 Nov;138:110271. doi: 10.1016/j.ijporl.2020.110271. Epub 2020 Aug 3.
Despite a reported incidence of HGMPE of 10%, proof of acid production, and an increased incidence of respiratory symptoms, the pediatric otolaryngology, swallowing and voice care literature is silent on this entity. This case series describes pediatric patients confirmed to have HGMPE with dysphonia and/or dysphagia.
Retrospective case series of Pediatric Voice, Resonance, and Swallowing Center patients at a tertiary Children's Hospital in 2019.
Tertiary academic medical center.
Three patients who underwent triple endoscopy for dysphonia or dysphagia were histologically diagnosed with HGMPE. Esophageal biopsies were otherwise normal. Two of the three patients resolved their primary aerodigestive symptoms following treatment with acid suppression and a protectant (sucralfate). The third patient reported significant improvement in symptoms by phone. The significance of this case series cannot be understated: 1) A need for increased awareness among pediatric otolaryngologists, voice care and swallowing professionals of this entity given its relatively common incidence of 10% offset by a dearth of presentations & scientific publications in our literature clearly exists. 2) Otolaryngologists have abandoned operative upper aerodigestive tract endoscopy in lieu of office-based less comprehensive videolaryngostroboscopy and fiberoptic endoscopic evaluation of swallowing. HGMPE & other esophageal disorders (i.e. eosinophilic esophagitis) support revisiting triple endoscopy in select patients where office endoscopy has failed to diagnose and successfully treat such patients. 3) Both acid suppression therapy and a protectant (sucralfate) may be useful in these patients. 4) Modification of rigid esophagoscopy technique to carefully assess the introitus and superior esophageal segment is paramount 5) Otolaryngologists over-diagnose & over-treat laryngopharyngeal reflux. The pediatric & adult literature is replete with significant safety warnings associated with acid suppression therapy and guidelines admonish their indiscriminate use, raising the liability bar of empiric treatment. Large scale prospective, randomized and controlled studies are needed to confirm the pathophysiologic role of this entity in pediatric aerodigestive disorders.
HGMPE is a clinical entity that can be easily missed upon swift entry into the esophagus with rigid endoscopy. Careful scrutiny and visualization of the proximal esophagus is critical in order to identify HGMPE, as there is a higher rate of laryngospasm, stricture, and potentially neoplasm in this population.
尽管有报道称 HGMPE 的发病率为 10%，存在酸产生和呼吸道症状发生率增加，但儿科耳鼻喉科、吞咽和语音护理文献对此问题仍未涉及。本病例系列描述了经证实患有 HGMPE 并伴有发声障碍和/或吞咽困难的儿科患者。
对 2019 年一家三级儿童医院的儿科语音、共鸣和吞咽中心患者进行回顾性病例系列研究。
三级学术医疗中心。
3 名因发声障碍或吞咽困难而行三重内窥镜检查的患者经组织学诊断为 HGMPE。食管活检均正常。其中 2 例患者在接受抑酸和保护剂（硫糖铝）治疗后，主要的气消化道症状得到缓解。第 3 例患者通过电话报告症状显著改善。本病例系列的意义不可低估：1）鉴于其发病率相对较高（10%），但在我们的文献中，其临床表现和科学出版物却明显缺乏，因此，儿科耳鼻喉科医生、语音护理和吞咽专业人员对此类疾病应有更高的认识。2）耳鼻喉科医生已放弃用于上呼吸道的手术内窥镜检查，转而采用基于办公室的不那么全面的视频喉镜频闪检查和纤维内镜吞咽评估。对于经办公室内窥镜检查未能诊断并成功治疗的患者，HGMPE 和其他食管疾病（如嗜酸性食管炎）支持重新考虑三重内窥镜检查。3）抑酸治疗和保护剂（硫糖铝）可能对这些患者有用。4）修改硬性食管镜技术以仔细评估入口和食管上段至关重要。5）耳鼻喉科医生过度诊断和过度治疗喉咽反流。儿科和成人文献中充斥着与抑酸治疗相关的重大安全警告，以及关于其随意使用的指南，这提高了经验性治疗的法律责任门槛。需要进行大规模的前瞻性、随机对照研究，以确认该实体在儿科气消化道疾病中的病理生理作用。
HGMPE 是一种临床实体，如果在使用硬性内镜快速进入食管时不加小心，很容易被遗漏。仔细检查和观察近端食管对于识别 HGMPE 至关重要，因为在该人群中，喉痉挛、狭窄和潜在肿瘤的发生率更高。
