Mondragon F, Arana J, Tovar J A, Traba L, Garay J, Nogues A
Z Kinderchir. 1985 Dec;40(6):361-3. doi: 10.1055/s-2008-1059750.
Nasal regurgitation of milk and choking after feeding were observed in a 1,450 g newborn boy. A nasogastric tube was inserted and several episodes of aspiration pneumonia occurred after every interruption of gavage. Weight gain was very slow. At the age of 7 months, cineradiographic studies depicted cricopharyngeal spasm and passage of the barium into the nasopharynx and larynx. Pharyngo-oesophageal manometry showed incoordination, high cricopharyngeal pressure and incomplete relaxation of the muscle. Extended lower oesophageal pH-metering revealed severe gastro-oesophageal reflux. After cricopharyngeal myotomy and fundoplication the patient recovered, x-ray findings improved, and so did manometry except for a persistent incoordination. Functional studies are mandatory for diagnosis of this complex clinical pattern. The need for ruling out gastrooesophageal reflux before myotomy in order to prevent subsequent severe aspiration, is pointed out.
在一名体重1450克的男婴身上观察到喂奶后牛奶经鼻腔反流和呛噎现象。插入了鼻胃管，每次管饲中断后均发生数次吸入性肺炎。体重增长非常缓慢。7个月大时，动态放射学研究显示环咽肌痉挛，钡剂进入鼻咽部和喉部。咽食管测压显示不协调、环咽肌压力高以及肌肉不完全松弛。延长的食管下段pH值测量显示严重的胃食管反流。行环咽肌切开术和胃底折叠术后，患者康复，X线检查结果改善，测压结果也有所改善，但仍存在持续的不协调。对于这种复杂的临床症状，必须进行功能研究以明确诊断。文中指出，在进行肌切开术之前需要排除胃食管反流，以防止随后发生严重的误吸。
