Croese John, Fairley Stephen K, Masson John W, Chong André K H, Whitaker David A, Kanowski Peter A, Walker Neal I
Department of Gastroenterology, The Townsville Hospital, Townsville, Australia.
Gastrointest Endosc. 2003 Oct;58(4):516-22. doi: 10.1067/s0016-5107(03)01870-4.
Eosinophilic esophagitis in adults is regarded as unusual, being diagnosed mostly in young men presenting with dysphagia. Mucosal furrows are a sentinel endoscopic feature. This study examined the demographic and clinical profile of adults with eosinophilic esophagitis seen from 1981 to 2002.
All patients from an Australian provincial city (population 198,000) with otherwise unexplained eosinophilic inflammation of the squamous epithelium (>/=30 eosinophils per high-power field) were included in a retrospective review.
A diagnosis of eosinophilic esophagitis was made in 31 patients (24 men, 7 women; mean age 34 years, range 14-77 years). The diagnosis was made in 19 (61%) of the 31 patients during the most recent 2 years (none between 1981 and 1994 vs. 12 between 1995-2000 vs. 19 between 2000-2001). Esophageal mucosal furrows were present in 30 (97%), a finding infrequently recognized before 2001. Dysphagia was documented in 26 (89%). Symptoms had been present for long periods before diagnosis (mean 54 months; range 0-180 months), and diagnosis was delayed in 7 (mean 81 months, range 20-144 months) because sentinel features were overlooked at endoscopy. Strictures, often evident only as a result of mucosal shearing during dilation, were present in 17 (57%). Esophageal dilation preformed in 17 (mean 3.4 dilations per patient, range 1-13) consistently relieved symptoms; tears were recorded in 13 (87%), but no serious complication resulted.
Eosinophilic esophagitis in adults of all ages is more common than recognized. Mucosal furrows are easily overlooked at endoscopy although this finding is an important clue to diagnosis. Strictures, a frequent consequence, can be safely managed by dilation.
成人嗜酸性粒细胞性食管炎被认为较为少见，大多在出现吞咽困难的年轻男性中被诊断出来。黏膜皱襞是一种标志性的内镜特征。本研究调查了1981年至2002年间所见的成人嗜酸性粒细胞性食管炎患者的人口统计学和临床特征。
对来自澳大利亚一个省会城市（人口19.8万）的所有患者进行回顾性研究，这些患者存在无法解释的鳞状上皮嗜酸性粒细胞炎症（每高倍视野≥30个嗜酸性粒细胞）。
31例患者（24例男性，7例女性；平均年龄34岁，范围14 - 77岁）被诊断为嗜酸性粒细胞性食管炎。在这31例患者中，19例（61%）是在最近2年确诊的（1981年至1994年无确诊病例，1995年至2000年有12例，2000年至2001年有19例）。30例（97%）存在食管黏膜皱襞，这一发现在2001年前很少被认识到。26例（89%）有吞咽困难的记录。症状在诊断前已存在很长时间（平均54个月；范围0 - 180个月），7例（平均81个月，范围20 - 144个月）诊断延迟，因为在内镜检查时忽略了标志性特征。17例（57%）存在狭窄，通常仅在扩张过程中由于黏膜剪切才明显。17例患者进行了食管扩张（平均每位患者3.4次扩张，范围1 - 13次），症状持续缓解；13例（87%）有撕裂记录，但未导致严重并发症。
各年龄段成人的嗜酸性粒细胞性食管炎比人们认识到的更为常见。内镜检查时黏膜皱襞容易被忽视，尽管这一发现是诊断的重要线索。狭窄是常见后果，可通过扩张安全处理。
