Staiano A, Cucchiara S, De Vizia B, Andreotti M R, Auricchio S
Department of Clinical Pediatrics, 2nd School of Medicine, Naples, Italy.
J Pediatr Gastroenterol Nutr. 1987 Nov-Dec;6(6):892-8. doi: 10.1097/00005176-198711000-00012.
Dysfunction of the upper esophageal sphincter was found in five out of 44 children with gastroesophageal reflux. Three of the five children had mental retardation associated with Silver Russell syndrome, 5p syndrome, or minimal change myopathy. The five patients had swallowing disorders, vomiting, and failure to thrive; four also had pulmonary aspiration. Esophageal manometry showed incomplete upper esophageal sphincter relaxation in two patients, upper esophageal sphincter relaxation incoordinated with pharyngeal contractions in two other patients, and both incomplete and incoordinated upper esophageal sphincter relaxation in the last patient. Intensive and successful treatment of gastroesophageal reflux did not improve swallowing or symptoms of pulmonary aspiration in four children. The fifth patient underwent cricopharyngeal myotomy, with complete resolution of respiratory and swallowing symptoms. It is suggested that a dysfunction of the upper esophageal sphincter, either primary or secondary to neuromuscular disorders, may play a role in the swallowing disorders and respiratory symptoms of pediatric patients.
在44例胃食管反流患儿中，有5例发现存在上食管括约肌功能障碍。这5例患儿中有3例伴有与Silver Russell综合征、5p综合征或微小病变型肌病相关的智力发育迟缓。这5例患者均有吞咽障碍、呕吐及生长发育迟缓；4例还存在肺误吸。食管测压显示，2例患者上食管括约肌松弛不完全，另外2例患者上食管括约肌松弛与咽部收缩不协调，最后1例患者上食管括约肌松弛既不完全又不协调。4例患儿接受积极有效的胃食管反流治疗后，吞咽功能或肺误吸症状并未改善。第5例患者接受了环咽肌切开术，呼吸和吞咽症状完全缓解。提示上食管括约肌功能障碍，无论是原发性的还是继发于神经肌肉疾病，都可能在小儿患者的吞咽障碍和呼吸道症状中起作用。
