胃食道逆流與兒童氣道疾患

Gastroesophageal Reflux and Pediatric Airway Disorders

戴任恭(Zen-Rong Dai) ； 吳俊仁(Jun-Ren Wu)

《Acta Paediatrica Taiwanica》 43卷s期 (2002/11) Pp. 1-8

https://doi.org/10.7097/APT.200211.0001

摘要

胃食道逆流(gastroesophageal reflux,GER)乃是胃內含物反向流回食道之現象。有時它可被接受爲短暫無害的生物現象。但，約有20%的嬰幼兒，是被視爲病理性GER。其診斷工具包括：食道24小時酸鹼值監測、放射性顯影研究、核子醫學影像、食道活體組織檢、支氣管鏡、食道鏡及喉鏡檢查。GER發生時，體內會藉著防護性反射機轉，來防止氣道進一步接觸胃內逆流物。罹患復發性肺炎、反應性氣道疾患、呼吸暫停、會厭軟販輕化症、復發性哮吼、嘎聲以及聲門下狹窄等疾病之兒童，被發現有較高之發生率。當然，目前仍不能確定其與GER之因果相關；可能導因於不健全的防衛性機轉，造成顯微吸入現象
(microaspiration)。也有可能是因逆流物滯貿留於食道，而引發過強的反射動作。其內科治療包括促動性療法及抑制酸度療法，雖可減輕食道炎與呼吸暫停，但無法防止吸入現象。如內科治療失敗則改以外科介入治療，其多樣性手術方法，隨著病童情況不同，而有不同的適應症，仍有等長期性及評估。

關鍵字

胃食道逆流 ； 食道括約肌 ； 食道酸鹼值偵測 ； 復發性肺炎 ； 復發性哮吼

並列摘要

Gastroesophageal reflux (GER) occurs when the stomach contents pass retrograde into the esophagus. Brief episodes of GER, harmless to airway mucosa, occur in normal subject. The occurrence of pathological GER is about 20 % in infants. The diagnostic tests included esophageal 24 hr pH probe, radiographic contrast studies, gastric nuclear scintigraphy, esophageal biopsy, bronchoscopy, esophagoscopy and laryngoscopy. The complicated reflex mechanisms could protect the airway from exposure to refluxed gastric contents. There was high incidence of GER noted in children with recurrent pneumonia, laryngomalasia, spasmodic croup, reactive airway disease, apnea, subglottic stenosis, tracheoesophageal fistula and esophageal atresia.Although the mechanism is still unclear, they may be caused 1) by microaspiration, representing inadequate airway protection mechanism, or 2) by reflexive responses to esophageal refluxate, called overre flective airway protection. Conservative lifestyle measures for treating supraesophageal manifestations of infantile GER, such as spitting up, chest pain, dysphagia and globus hystericus, include prone positioning and high-energy thickened feedings. Prokinetic and acid-suppressing therapies were commonly given, but their efficacy is incompletely established. Fundoplication is not indicated if nonsurgical management can prevent serious problems during the growing when much more symptoms spontaneously resolve.

並列關鍵字

gastroesophageal reflux (GER) ； esophageal sphincter ； esophageal pH probe ； recurrent pneumonia ； recurrent croup