Nonspecific esophageal motility disorders in children without gastroesophageal reflux.
Nonspecific esophageal motility disorders in children without gastroesophageal reflux.
复制标题
无胃食管反流的儿童非特异性食管动力障碍。
DOI：
10.1097/00005176-199905000-00007
复制
发表时间：
1999
影响因子：
2.9
通讯作者：
Berezin,SH
中科院分区：
文献类型：
--
作者：
Rosario,JA;Medow,MS;Halata,MS;Bostwick,HE;Newman,LJ;Schwarz,SM;Berezin,SH
非特异性食道动力障碍(NEMD)已在高达50%的伴有非心源性胸痛或吞咽困难的成年人中被发现。本研究旨在了解有上消化道症状的儿童中NEMDs的发生率，并评估有这些测压异常的儿童的临床病程。方法本研究选择154名有上消化道、吞咽相关症状的4~18岁儿童，平均年龄11.6±2.6岁。对154例患儿进行24小时食道内pH监测、食道测压，其中109例(71%)经pH检测确诊为esophagogastroduodenoscopy.ResultsGastroesophageal反流(GER)，70例患儿经活检证实为食管炎。45例无GER患儿中有30例(67%)食道测压结果异常。在无GER的患者中，17例诊断为各种运动障碍，其余13例(平均年龄10.6±2.7岁；男孩10例，女孩3例)被诊断为NEMDs。GER患者的食管波传播正常，但GER患者的平均下食道括约肌压力明显低于NEMDs儿童。患有NEMDs的儿童表现出一系列不同的症状，包括13名患者中的4名食道食物嵌塞。在36.2±4.3个月的随访期内，13例NEMDS患者的治疗干预与临床病程均无相关性。13例中有6例症状改善，其中3例未给予药物治疗。结论NEMDs是有上消化道症状且无GER的儿童中常见的一组食道测压异常。食物嵌塞似乎是一种相对常见的并发症，对于有这种发现的儿童，应该考虑使用NEMD。
BackgroundNonspecific esophageal motility disorders (NEMDs) have been identified in up to 50% of adults with noncardiac chest pain or dysphagia. This study sought to determine the incidence of NEMDs in children with upper gastrointestinal tract symptoms and to evaluate the clinical course of pediatric patients with these manometric abnormalities.MethodsThe study involved 154 children aged 4 to 18 years (mean age, 11.6 ± 2.6 years [SE]) who had upper gastrointestinal, swallowing‐related symptoms. The children were evaluated by 24‐hour intraesophageal pH monitoring, esophageal manometry, and esophagogastroduodenoscopy.ResultsGastroesophageal reflux (GER) was diagnosed by pH study in 109 (71%) of 154 patients, and examination of biopsy specimens demonstrated esophagitis in 70 children with GER. Results of esophageal manometry were abnormal in 30 (67%) of 45 children without GER. A variety of motility disorders were diagnosed in 17 of the patients without GER, whereas NEMDs were diagnosed in the remaining 13 children (mean age, 10.6 ± 2.7 years; 10 boys, 3 girls). Patients with GER showed normal esophageal wave propagation; however, mean lower esophageal sphincter pressure was significantly lower in patients with GER than in children with NEMDs. The children with NEMDs exhibited a diverse array of symptoms, including esophageal food impaction in 4 of the 13 patients. During a 36.2 ± 4.3‐month follow‐up period, no correlation was found between therapeutic intervention and clinical course in the 13 patients with NEMDs. Symptomatic improvement occurred in 6 of 13 patients, including 3 children for whom no pharmacologic therapy was prescribed.ConclusionsThese data indicate that NEMDs represent a common group of esophageal manometric abnormalities in children with upper gastrointestinal tract symptoms and without GER. Food impaction appears to be a relatively frequent complication, and NEMDs should be considered in children who have this finding.