Orenstein S R, Shalaby T M, Di Lorenzo C, Putnam P E, Sigurdsson L, Mousa H, Kocoshis S A
Division of Pediatric Gastroenterology, University of Pittsburgh School of Medicine, and Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Am J Gastroenterol. 2000 Jun;95(6):1422-30. doi: 10.1111/j.1572-0241.2000.02073.x.
Eosinophilic esophagitis, previously confused with esophageal inflammation due to gastroesophageal reflux, has recently begun to be distinguished from it. We undertook this analysis of our large series of children with the condition to clarify its spectrum: its presenting symptoms; its relation to allergy, respiratory disease, and reflux; its endoscopic and histological findings; and its diagnosis and therapy.
We analyzed the details of our clinical series of 30 children with eosinophilic esophagitis, defining it as > or =5 eosinophils per high power field in the distal esophageal epithelium. Retrospective chart review was supplemented by prospective, blinded, duplicate quantitative evaluation of histology specimens, and by telephone contact with some families to clarify subsequent course. Presentation and analysis of the series as a whole is preceded by a case illustrating a typical presentation with dysphagia and recurrent esophageal food impactions.
Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an associated finding in most patients, and many have concomitant asthma or other chronic respiratory disease. A subtle granularity with furrows or rings is newly identified as the endoscopic herald of histological eosinophilic esophagitis. Histological characteristics include peripapillary or juxtaluminal eosinophil clustering in certain cases. Association with eosinophilic gastroenteritis occurs, but is not common. Differentiation from gastroesophageal reflux disease is approached by analyzing eosinophil density and response to therapeutic trials. Therapy encompasses dietary elimination and anti-inflammatory pharmacotherapy.
Awareness of the spectrum of eosinophilic esophagitis should promote optimal diagnosis and treatment of this elusive entity, both in children and in adults.
嗜酸性粒细胞性食管炎曾被误诊为胃食管反流所致的食管炎症，近来才开始与之区分开来。我们对大量患有该疾病的儿童进行了此项分析，以明确其疾病范围：包括其呈现的症状；与过敏、呼吸系统疾病及反流的关系；内镜及组织学检查结果；以及其诊断和治疗方法。
我们分析了30例嗜酸性粒细胞性食管炎患儿的临床资料，将其定义为远端食管上皮每高倍视野嗜酸性粒细胞≥5个。回顾性病历审查辅以对组织学标本进行前瞻性、盲法、重复定量评估，并通过电话联系部分家庭以明确后续病程。在对整个病例系列进行呈现和分析之前，先展示一个以吞咽困难和反复食管食物嵌塞为典型表现的病例。
呈现的症状包括呕吐、疼痛和吞咽困难（部分伴有嵌塞或狭窄）。过敏，尤其是食物过敏，在大多数患者中是一个相关发现，许多患者还伴有哮喘或其他慢性呼吸系统疾病。一种伴有沟纹或环的细微颗粒状表现被新确定为组织学嗜酸性粒细胞性食管炎的内镜先兆。组织学特征在某些病例中包括乳头周围或管腔旁嗜酸性粒细胞聚集。与嗜酸性粒细胞性胃肠炎有关联，但并不常见。通过分析嗜酸性粒细胞密度和对治疗试验的反应来与胃食管反流病进行鉴别。治疗包括饮食排除和抗炎药物治疗。
了解嗜酸性粒细胞性食管炎的疾病范围应有助于对这一难以捉摸的疾病在儿童和成人中进行最佳诊断和治疗。
