Cury E K, Schraibman V, Faintuch S
Division of Pediatric Surgery, Department of Surgery, Federal University of São Paulo, São Paulo, Brazil.
J Pediatr Surg. 2004 Feb;39(2):e4-7. doi: 10.1016/j.jpedsurg.2003.10.028.
BACKGROUND/PURPOSE: Children presenting with persistent symptoms attributed to gastroesophaeal reflux disease (GERD) that are unresponsive to both medical and surgical therapies are commonly submitted to esophageal biopsies, the results of which show an abnormal presence of eosinophils. In this setting, eosinophilic esophagitis may be the correct diagnosis. The purpose of this report is to clarify the importance of esophageal eosinophilic infiltration, regardless of whether associated with acid reflux, ie, as an independent symptomatic entity, when treating a patient with refractory GERD.
Two boys, aged 8 and 7 years, had the classic symptoms of GERD. They were treated with antacid without improvement of the esophagic lesions. Subsequent esophageal biopsy results showed marked eosinophilic infiltration. From this moment on, eosinophilic esophagitis started to be considered the main diagnosis.
Although eosinophilic infiltration caused by GERD is very frequently found in esophageal biopsy, in case of refractory drug treatment and microscopic findings of a great number of eosinophils and mast cells, eosinophilic esophagitis must be considered. This disease is better treated with corticoids instead of antacid drugs. It explains the reason some patients do not respond to antacid and surgical treatment and remain symptomatic with esophagic lesions.
In refractory cases of GERD, eosinophilic esophagitis must be considered before any surgical measure.
背景/目的：对于那些表现出归因于胃食管反流病（GERD）的持续症状且对药物和手术治疗均无反应的儿童，通常会进行食管活检，结果显示存在异常的嗜酸性粒细胞。在这种情况下，嗜酸性粒细胞性食管炎可能是正确的诊断。本报告的目的是阐明食管嗜酸性粒细胞浸润的重要性，无论其是否与酸反流相关，即在治疗难治性GERD患者时，作为一种独立的有症状的疾病实体。
两名男孩，年龄分别为8岁和7岁，有GERD的典型症状。他们接受了抗酸治疗，但食管病变没有改善。随后的食管活检结果显示有明显的嗜酸性粒细胞浸润。从这时起，嗜酸性粒细胞性食管炎开始被视为主要诊断。
虽然GERD引起的嗜酸性粒细胞浸润在食管活检中很常见，但在药物治疗难治且显微镜下发现大量嗜酸性粒细胞和肥大细胞的情况下，必须考虑嗜酸性粒细胞性食管炎。这种疾病用皮质类固醇治疗比用抗酸药物更好。这解释了为什么一些患者对抗酸和手术治疗无反应，食管病变仍有症状。
在GERD的难治性病例中，在采取任何手术措施之前必须考虑嗜酸性粒细胞性食管炎。
