思春期のBarrett食道の診断につながる持続的な嘔吐と体重減少

Persistent Vomiting and Weight Loss Leading to the Diagnosis of Barrett's Esophagus in an Adolescent.

• Alyssa Lorenze
• Collin John
• Brian D Riedel
• Linda S Nield

抄録

消化性食道狭窄を合併した小児のBarrett食道の特徴はあまり知られておらず，その有病率も不明である．嘔吐の再発を伴う嚥下障害を呈し，病歴も限定的であった青年期のBarrett食道狭窄を合併した1例を報告する。軽度の知的障害を持つ13歳の男性が、2ヶ月間の嚥下障害と嘔吐の再発、固形物と液体の両方に対する不耐性を理由に当施設に転院してきた。身体検査と検査値は正常範囲内であり，全血球数とその差，血清電解質，グルコース，アミラーゼ，リパーゼ，肝機能検査と腎機能検査，甲状腺刺激ホルモン値を含む．バリウム食道画像は、近位および中間食道の持続的な局所的な狭窄を明らかにした。食道内視鏡検査で円周方向の狭窄と生検でびらん性食道炎と診断された．パントプラゾールの高用量投与を開始し，内視鏡ガイド付きバルーン拡張術を連続的に施行したところ，症状は著明に改善した．Barrett食道を伴う消化性狭窄は小児ではまれである。発達の遅れがある場合には，嘔吐という一般的な症状を有する小児の鑑別診断に含めるべきである。腺癌への進行を防ぐためには、内視鏡的バルーン拡張術やプロトンポンプ阻害薬による積極的な治療が必要である。

Barrett's esophagus in children with peptic strictures has not been well characterized, and its prevalence is unknown. We report a case of peptic esophageal stricture with Barrett's esophagus in an adolescent patient who presented with dysphagia with recurrent episodes of vomiting and limited medical history. A 13-year-old male with mild intellectual disability was transferred to our facility due to a two-month history of dysphagia with recurrent episodes of vomiting and intolerance to both solids and liquids. Physical examination and laboratory values were within normal limits, including complete blood count and differential, serum electrolytes, glucose, amylase, lipase, liver and kidney function tests, and thyroid-stimulating hormone level. Barium esophagram revealed persistent focal narrowing of the proximal and mid-esophagus. An esophageal endoscopy revealed a snug circumferential stricture and biopsy consistent with erosive esophagitis. The patient was started on high dose pantoprazole and underwent serial endoscopic guided balloon dilations with marked improvement in symptoms. Peptic stricture with Barrett's esophagus is rare in children. It should be included in the differential diagnosis of a child with the common symptom of vomiting in the setting of developmental delay. Vigorous treatment with endoscopic balloon dilation and proton pump inhibitors is necessary to prevent the progression into adenocarcinoma.

Copyright © 2020, Lorenze et al.