Luis A L, Riñon C, Encinas J L, Prieto G, Molina M, Sarria J, Olivares P, Tovar J A
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
Eur J Pediatr Surg. 2006 Dec;16(6):399-402. doi: 10.1055/s-2006-924747.
Eosinophilic esophagitis (EoE) is an emergent condition in which a mucosal infiltrate of > 20 eosinophils per high power microscopic field is accompanied by motor disturbances that may cause food impaction in the absence of esophageal stricture. We report a series of such cases to point out the potential involvement of pediatric surgeons in diagnosis and treatment. Furthermore, data on the motor function of the esophagus investigated manometrically is included.
Thirteen patients with EoE were referred to our emergency room for acute food bolus impaction. Their median age at diagnosis was 12 years (range 7.6-14.4). History of allergy, endoscopy with biopsy and esophageal function (24-h combined ambulatory manometry with simultaneous pH-metry) were investigated.
In 7 patients emergency endoscopic extraction of the impacted bolus was necessary. Allergic tests were positive in eight patients. The pH probe showed gastroesophageal reflux in two cases. Upon endoscopy, typical features of EoE (esophageal trachealization and whitish papular exudates) were found. Ambulatory 24-h manometry revealed abnormal motility of the distal esophagus with strikingly high amplitudes (> 150 mmHg) and long duration (> 7 sec) of the waves, particularly during the night. Six patients responded rapidly to steroids and/or antiallergic treatment. The remaining patients had a good outcome with dietary treatment alone.
EoE is an emergent condition that may involve the pediatric surgeon in both the diagnosis and treatment. Typical endoscopic findings and biopsy are required for proper diagnosis. Ambulatory manometry reveals a marked propulsive dysfunction that explains impaction. This dysfunction is reversible, since the symptoms usually disappear with steroids or antiallergic treatment.
嗜酸性粒细胞性食管炎（EoE）是一种新出现的疾病，每高倍显微镜视野中黏膜嗜酸性粒细胞浸润超过20个，并伴有运动障碍，在无食管狭窄的情况下可导致食物嵌塞。我们报告一系列此类病例，以指出小儿外科医生在诊断和治疗中的潜在参与情况。此外，还纳入了通过测压法研究的食管运动功能数据。
13例EoE患者因急性食物团块嵌塞被转诊至我们的急诊室。他们诊断时的中位年龄为12岁（范围7.6 - 14.4岁）。调查了过敏史、内镜检查及活检以及食管功能（24小时联合动态测压并同步进行pH值测定）。
7例患者需要急诊内镜下取出嵌塞的团块。8例患者过敏试验呈阳性。pH探头显示2例有胃食管反流。内镜检查时，发现了EoE的典型特征（食管气管化和白色丘疹样渗出物）。24小时动态测压显示食管远端运动异常，波幅极高（>150 mmHg）且持续时间长（>7秒），尤其是在夜间。6例患者对类固醇和/或抗过敏治疗反应迅速。其余患者仅通过饮食治疗就取得了良好效果。
EoE是一种新出现的疾病，可能使小儿外科医生参与诊断和治疗。正确诊断需要典型的内镜检查结果和活检。动态测压显示明显的推进功能障碍，这解释了食物嵌塞的原因。这种功能障碍是可逆的，因为症状通常会随着类固醇或抗过敏治疗而消失。
