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.

中文翻译：

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食管近端异位胃黏膜（HGMPE）及其在小儿发音障碍和吞咽困难中的潜在作用。

目的

尽管据报道HGMPE的发生率为10％，有产酸的证据，并且呼吸系统症状的发生率也有所增加，但儿科耳鼻喉科，吞咽和声音保健文献对此均保持沉默。本病例系列描述了已确诊患有HGMPE伴有声音障碍和/或吞咽困难的小儿患者。

方法

三级儿童医院的儿科语音，共鸣和吞咽中心患者回顾性病例系列（2019年）。

设置

高等学术医学中心。

结果汇总

经组织学诊断为HGMPE的三名接受了三重内镜检查的声躁或吞咽困难的患者。食管活检正常。三名患者中有两名在用抑酸剂和保护剂（硫糖铝）治疗后缓解了其主要的消化道症状。第三名患者通过电话报告症状明显改善。该病例系列的重要性不可低估：1）儿科耳鼻喉科医生，声音护理和吞咽专业人员对该实体的认识有所提高，因为相对常见的发病率是10％，但文献中缺乏演讲和科学出版物的现象很明显存在。2）耳鼻喉科医生放弃了基于上消化道的手术内窥镜检查，而不是基于办公室的不太全面的视频鼻咽镜检查和光纤内窥镜吞咽评估。HGMPE和其他食道疾病（嗜酸性食管炎）可支持某些内镜检查未能重新诊断和成功治疗此类患者的三重内镜检查。3）抑酸治疗和保护剂（硫糖铝）均可用于这些患者。4）改良硬性食管镜检查技术以仔细评估口部和食管上段是最重要的。5）耳鼻喉科医生过度诊断和治疗喉咽返流过多。儿科和 成人文献中充斥着大量与酸抑制疗法相关的安全警告，指南警告其不加选择地使用，从而提高了经验治疗的责任门槛。需要大规模的前瞻性，随机和对照研究来证实该实体在儿科胃肠道疾病中的病理生理作用。

结论

HGMPE是一种临床实体，通过硬性内窥镜检查迅速进入食道很容易错过。为了鉴别HGMPE，仔细检查和观察近端食道是至关重要的，因为该人群中喉痉挛，狭窄和潜在的肿瘤发生率更高。