Kuroki H, Ishikawa N, Kurosaki T, Niimi H
Department of Pediatrics, School of Medicine, Chiba University, Japan.
Acta Paediatr Jpn. 1996 Aug;38(4):357-60. doi: 10.1111/j.1442-200x.1996.tb03506.x.
Two infants with intractable wheezing and moist cough were referred to Chiba Municipal Kaihin Hospital. Their symptoms were persistent even after the usual treatment for respiratory disease. No definite etiological agents were detected. They usually gagged while feeding and barium swallow tests revealed nasopharyngeal reflux and cricopharyngeal incoordination. One of the patients had remarkably high titers of IgE and IgE RAST of cow's milk before she received treatment with thickened formula. She also had peripheral eosinophilia and nasal eosinophilia. These findings were thought to be caused by nasopharyngeal reflux. Four months after therapy commenced, those titers and symptoms were greatly reduced. The clinical and roentgenographic findings in these infants, and their response to therapy, strongly support a causal relationship between nasopharyngeal reflux and wheezing. Therefore, nasopharyngeal reflux should be considered when a baby has intractable wheezing, even when there is no developmental problem.
两名患有顽固性喘息和湿性咳嗽的婴儿被转诊至千叶市海滨医院。即使在接受了常规的呼吸道疾病治疗后，他们的症状仍持续存在。未检测到明确的病原体。他们在进食时通常会出现哽咽，钡餐吞咽试验显示有鼻咽反流和环咽肌不协调。其中一名患者在接受增稠配方奶治疗前，牛奶特异性IgE和IgE RAST滴度显著升高。她还伴有外周血嗜酸性粒细胞增多和鼻嗜酸性粒细胞增多。这些发现被认为是由鼻咽反流引起的。治疗开始四个月后，这些滴度和症状大幅降低。这些婴儿的临床和影像学表现以及他们对治疗的反应，有力地支持了鼻咽反流与喘息之间的因果关系。因此，当婴儿患有顽固性喘息时，即使没有发育问题，也应考虑鼻咽反流的可能。
