Association between Gastroesophageal Reflux and Endobronchial Carcinoid: A Case Report

Abstract

Children with neurological disorders may suffer from gastroesophageal reflux disease (GERD). Typical symptoms are vomiting, regurgitation and hematemesis. Patients present with respiratory symptoms only in cases with swallowing disorders causing chronic airway aspiration. We report the case of a patient affected by chromosome 8 p deletion syndrome with mental retardation, referred to our unit for suspected GERD. Chest X‐ray, performed at admission for coexisting respiratory complaints, showed left lower lobe pneumonia; esophageal pH monitoring and upper endoscopy were normal for GERD. To rule out chronic airway aspiration, gastroesophageal 99 mTc scintigraphy with lung scan 18 to 24 h after a test meal and video fluoroscopy swallowing study were performed, both negative. Two months later, a second episode of left lower lobe pneumonia occurred. A chest CT scan was performed and showed an endobronchial mass; the biopsy taken during the broncoscopy was not conclusive. Surgical excision resulted in a diagnosis of pulmonary carcinoid. Bronchial carcinoids, although rare, should be taken into consideration as a potential cause of recurrent pneumonia even in the presence of demonstrated GERD where severe respiratory infections only occur with coexisting chronic pulmonary aspiration, even in neurologically impaired people.

Key words

Bronchial carcinoid - GERD - mental retardation - recurrent pneumonia

References

• 1 Vandenplas Y, Hassall E. Mechanisms of gastroesophageal reflux and gastroesophageal reflux disease.  J Pediatr Gastroenterol Nutr. 2002;  35 119-136
• 2 De Veer A J E, Bos J T, Niezen-de Boer R C et al. Symptoms of gastroesophageal reflux disease in severely mentally retarded people: a systematic review.  BMC Gastroenterology. 2008;  8 23-34
• 3 Owayed A F, Canpbell D M, Wang E E L. Underlying causes of recurrent pneumonia in children.  Arch Pediatr Adolesc Med. 2000;  14 190-194
• 4 Weir K, McMahon S, Barry L et al. Oropharyngeal aspiration and pneumonia in children.  Pediatr Pulmonology. 2007;  42 1024-1031
• 5 Rudolph C D, Mazur L J, Liptak G S et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition.  J Pediatr Gastroenterol Nutr. 2001;  32 (Suppl. 2) S1-S31
• 6 Morton R E, Wheatley R, Minford J. Respiratory tract infections due to direct and reflux aspiration in children with severe neurodisability.  Dev Med Child Neurol. 1999;  41 329-334
• 7 Pappo A S, Furman W L. Management of infrequent cancers of childhood.. In: Pizzo P A, Poplack P G, eds. Principles and Practice of Pediatric Oncology.. New York: Lippincott Williams & Wilkins; 2005: 1172-1201
• 8 Bölükbas S, Eberlein M, Schirren J. A 30-year-old woman with only right-sided asthma?.  Thorac Cardiovasc Surg. 2010;  58 120-122