Evaluation of Gastroesophageal Reflux and Gastroesophageal Reflux Disease with Esophageal Endoscopy and Histology in Children

Objectives:The roles of esophageal endoscopy and mucosal biopsy in making diagnoses of gastroesophageal reflux( GER) and gastroesophageal reflux disease( GERD) were retrospectively examined in children.Methods:Thirty-four patients, whose ages ranged from 1 month to 18 years (median, 4 years), underwent diagnostic evaluation of GER/GERD. Group I patients( n=5) had symptoms suggesting GER, but had no underlying abnormalities. Group II patients( n=23) had chronic symptoms suggesting GERD and underlying abnormalities, neurologic impairment( n=22) and post-repair of esophageal atresia( n=1). Group III patients( n=6) were neurologically impaired but had no symptoms and underwent evaluation as a preoperative examination of gastrostomy placement. Reflux esophagitis was endoscopically graded according to the modified Los Angeles classification and grouped into grades?M, A, and?B. The results of GER studies and the histologic findings of reflux esophagitis were compared between these groups.Results:The parameters of 24-h pH monitoring were significantly higher in patients with grade?B than grade?M, and endoscopic grades improved after antireflux surgery along with the improvements in reflux index. There were no significant correlations between the endoscopic grade and the percentages of patients in whom histologic findings of reflux esophagitis were present.Conclusion:Esophageal endoscopy is useful for examining the severity of reflux esophagitis and monitoring the effect of treatment in children with GER/GERD. The modified Los Angeles classification can also be used for that purpose. Although treatment is seldom influenced by the results, histologic evaluation of the esophageal mucosa should be performed to exclude other disorders

キョウクウ センパ ニヨル ノウキョウ ガッペイ オ ミトメタ セイジュクガタ ジュウカク キケイシュ ノ 1レイ

症例は16 歳女性,咳嗽,発熱,左前胸部痛を主訴に来院.胸部CT にて内部不均一な径7 cm の前縦隔腫瘍及び左舌区・下葉の完全無気肺を確認,また,MRI にて前縦隔腫瘍内に脂肪組織と同一の吸収域を認め,成熟型奇形腫穿破による膿胸と診断.膿胸に対し胸腔内繊維素溶解療法,ドレナージ及び抗生剤にて加療,膿胸改善を確認した上で,前縦隔腫瘍摘出術施行,病理にて嚢胞性成熟型奇形腫と診断した.病理組織にて膵類似の腺組織を確認,穿破の原因として,腫瘍内膵酵素の存在が考えられた.成熟型縦隔奇形腫は穿破により重篤な合併症発生の危険性があり,また経過中悪性転化する可能性もあることから,早期の外科治療が重要と考えられた.A 16-year-old female visited our hospital, complaining ofcough, fever, and left precordial pain. Chest computed tomographyshowed a heterogeneous anterior mediastinal tumormeasuring 7 cm in diameter and complete atelectasis inthe lingula and lower lobe of the left lung. Magnetic resonanceimaging also showed an area of intensity identical tothat of adipose tissue in the anterior mediastinal tumor.Thus, empyema due to rupture of a mature teratoma wasdiagnosed. The empyema was treated with intra-pleural fibrinolytictherapy, drainage, and antibiotics. After confirmingresolution of the empyema, we resected the anteriormediastinal tumor and pathologically diagnosed it as cysticmature teratoma. Histopathological examination showedglandular tissue resembling the pancreas, suggesting thatthe rupture had been caused by pancreatic enzymes in thetumor. Mediastinal mature teratoma carries a risk of seriouscomplications developing due to rupture and the possibilityof malignant transformation during the diseasecourse. Thus, early surgical treatment is important

シンセイジ ニ タイスル ケイビテキ ジゾク ヨウアツ コキュウ ホウ ノ コウカ ト モンダイ テン

当院新生児集中治療室において経鼻的持続陽圧呼吸法を65例に施行し,その有効性と問題点について疾患別に検討した.出生後早期の呼吸障害である呼吸窮迫症候群では全例無効であったが,新生児一過性多呼吸では79%で有効であった.低出生体重児の慢性肺疾患では,抜管後の呼吸障害に85%で有効であった.無呼吸発作には,呼吸中枢の未熟性によるものには95%で有効であったが,薬剤の副作用による無呼吸に対しては無効であった.経鼻的持続陽圧呼吸法の合併症として,鼻部潰瘍および腹部膨満を3例に認めた.ただ,これらの合併症は,使用時間の短縮で減らすことが可能であると考えられた. Key Words: 新生児,経鼻的持続陽圧呼吸法,無呼吸発作We evaluated the effects and problems of nasal continuouspositive airway pressure (nasal CPAP) in 65 patientsadmitted to our neonatal intensive care unit. In neonateswith early onset respiratory problems after birth, nasalCPAP was effective for 79 % in transient tachypnea. However,no effect was observed in respiratory distress syndrome.Nasal CPAP was also effective for 85 % in post-extubationchronic lung disease and 95 % in apnea ofprematurity. Ulcers around the nose and abdominal distensionas adverse effects were observed in several neonates,however these risks may be reduced by shorting durationof nasal CPAP