NHÂN MỘT TRƯỜNG HỢP ÓI KÉO DÀI DO RỐI LOẠN NHU ĐỘNG THỰC QUẢN KHÔNG HIỆU QUẢ TẠI BỆNH VIỆN ĐA KHOA TÂM ANH TP. HỒ CHÍ MINH

Abstract

Background: Prolonged vomiting in children is a diagnostic challenge that requires a systematic exclusion of mechanical and functional causes. Ineffective esophageal motility is frequently underdiagnosed due to its atypical clinical presentation and the requirement for specialized diagnostic procedures.

Case report: A 14-year-old female was admitted with a one-year history of persistent vomiting occurring 5–7 minutes after meals, associated with a 15kg weight loss. Previous extensive evaluations, including four endoscopies, imaging studies, and psychological testing, were inconclusive. High-resolution manometry performed at Tam Anh General Hospital revealed 60% failed peristalsis with a normal median integrated relaxation pressure of 4.1 mmHg. These findings confirmed the diagnosis of ineffective esophageal motility according to the Chicago Classification version 4.0. The patient underwent dietary and behavioral modification combined with multimodal conservative treatment, including Itopride, Esomeprazole, and Alginate. At the one-month follow-up, vomiting frequency had decreased, and weight loss was stabilized.

Conclusion: Ineffective esophageal motility should be considered as a potential etiology for unexplained chronic vomiting in adolescents. Early utilization of high-resolution manometry is essential for definitive diagnosis and guiding appropriate management in pediatric patients with persistent upper gastrointestinal symptoms.