Heterotopic gastric mucosa of the proximal esophageal (HGMPE) and its potential role in pediatric dysphonia and dysphagia
| Autor: | Michael S. Weinstock, Joseph E. Dohar, Jeffrey P. Simons |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Biopsy Population Choristoma Esophageal Disorder Esophageal Diseases 03 medical and health sciences Laryngopharyngeal reflux Esophagus 0302 clinical medicine Swallowing 030225 pediatrics medicine Humans Child 030223 otorhinolaryngology education Eosinophilic esophagitis Retrospective Studies education.field_of_study medicine.diagnostic_test business.industry General surgery Infant General Medicine Dysphonia medicine.disease Dysphagia Endoscopy medicine.anatomical_structure Otorhinolaryngology Gastric Mucosa Pediatrics Perinatology and Child Health Female Esophagoscopy medicine.symptom Deglutition Disorders business |
| Zdroj: | International Journal of Pediatric Otorhinolaryngology. 138:110271 |
| ISSN: | 0165-5876 |
| DOI: | 10.1016/j.ijporl.2020.110271 |
| Popis: | Objective 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. Methods Retrospective case series of Pediatric Voice, Resonance, and Swallowing Center patients at a tertiary Children's Hospital in 2019. Setting Tertiary academic medical center. Summary of results 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. Conclusion 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. |
| Databáze: | OpenAIRE |
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