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Cricopharyngeal dysphagia and gastro-oesophageal reflux
Insights
This study highlights a rare case of infant feeding difficulties, identifying both cricopharyngeal spasm and severe gastro-oesophageal reflux. Surgical intervention improved symptoms, emphasizing the need for thorough pre-operative evaluation.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnostics
- Surgical Interventions
Background:
- Infantile feeding disorders can present with complex symptoms.
- Accurate diagnosis is crucial for effective management.
Observation:
- A newborn boy experienced nasal regurgitation, choking, and aspiration pneumonia.
- Failure to thrive and recurrent respiratory issues were noted.
Findings:
- Cineradiography revealed cricopharyngeal spasm and barium aspiration into the nasopharynx and larynx.
- Pharyngo-esophageal manometry indicated high cricopharyngeal pressure and incomplete relaxation.
- Extended lower esophageal pH monitoring showed severe gastro-esophageal reflux.
Implications:
- Combined cricopharyngeal spasm and gastro-esophageal reflux present a diagnostic challenge.
- Surgical myotomy and fundoplication led to clinical recovery.
- Ruling out gastro-esophageal reflux before cricopharyngeal myotomy is critical to prevent aspiration.
Abstract:
Nasal regurgitation of milk and choking after feeding were observed in a 1,450 g newborn boy. A nasogastric tube was inserted and several episodes of aspiration pneumonia occurred after every interruption of gavage. Weight gain was very slow. At the age of 7 months, cineradiographic studies depicted cricopharyngeal spasm and passage of the barium into the nasopharynx and larynx. Pharyngo-oesophageal manometry showed incoordination, high cricopharyngeal pressure and incomplete relaxation of the muscle. Extended lower oesophageal pH-metering revealed severe gastro-oesophageal reflux. After cricopharyngeal myotomy and fundoplication the patient recovered, x-ray findings improved, and so did manometry except for a persistent incoordination. Functional studies are mandatory for diagnosis of this complex clinical pattern. The need for ruling out gastrooesophageal reflux before myotomy in order to prevent subsequent severe aspiration, is pointed out.