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以抗胃酸逆流嘗試性療法排除巨大頸椎骨贅爲咽喉異常感之病因

The Use of Anti-reflux Therapy to Exclude a Large Cervical Osteophyte as the Etiology of Globus Pharyngitis

Abstracts


大多數的頸椎骨贅是沒有症狀的,少數頸椎骨贅可能造成吞嚥障礙或咽喉異常感症。一67歲女性,因咽喉異常感症及偶爾吞嚥困難10年求診於本院,理學檢查見到後咽壁有一隆起之硬質腫塊,鼻竇X光及食道攝影無異常發現,頸椎X光及電腦斷層顯示第1頸椎前結節有一明顯之骨贅,其他頸椎椎體間有骨刺形成,前方縱向韌帶呈現鈣化。由於病患拒絕手術切除該骨贅,經給予抗胃酸逆流嘗試性療法5週後,咽喉異常感消失。追蹤迄今已半年,情況依然穩定。因此,本個案之病症並非頸椎骨贅所致,可能與胃食道逆流至咽喉部位有關。期待能從本篇給予臨床醫師另一條不同的思路,在診治咽喉異常感症時,應考應胃食道逆流的可能性。

Parallel abstracts


Most cervical osteophytes are not clinically symptomatic, but some may contribute to swallowing disorder or globus pharyngis. A 67-year-old woman presented with globus pharyngis and occasional dysphagia for ten years. A protruded firm mass was noted over her retropharyngeal wall. Sinus X-ray and esophagogram did not show any abnormality. A cervical spine X-ray and a computed tomography showed an osteophyte developed from anterior tubercle of the atlas, spurs formed in the other inter-vertebral body joints, and anterior longitudinal ligament calcified. However, she refused any surgical removal of the osteophyte. Then, an anti-reflux therapeutic trial was recommended. Surprisingly, five weeks later, the globus pharyngis subsided. Over the following half a year, it was uneventful. Therefore, her globus pharyngis was attributable to laryngopharyngeal reflux instead of the cervical osteophyte. We introduce an alternative idea that globus pharyngis should be attributable to gastroesophageal reflux disease.

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