2015 Volume 18 Issue 1 Pages 31-35
A 9-year-old girl had vomited frequently after norovirus infection and lost 6 kg in weight in 2 months. After admission to our hospital, she underwent an upper gastrointestinal series. The movement of the digestive tract was good and the esophagus was not enlarged, but the passage of barium was delayed from the esophagus to the stomach. Although achalasia was not strongly suspected, we considered the possibility of increased pressure of the lower esophageal sphincter and administered sublingual nitroglycerin, which is the therapeutic medication for achalasia. The patient could eat food without vomiting for 20-30 minutes, during which time the nitroglycerin would be effective, and her body weight gradually increased. However, since her weight gain was limited, we examined her gastrointestinal tract endoscopically. The junction of the esophagus and stomach had stiffened and narrowed, and bled due to the endoscope camera. After the endoscopic examination, the treatment with nitroglycerin was stopped but she could consume food with little vomiting. We thought that reflux esophagitis after norovirus infection had induced lower esophageal stricture, and that the endoscopic examination had exerted a Bougie effect on this stricture.
