Francalanci Paola, De Angelis Paola, Minnei Francesca, Diomedi Camassei Francesca, Torroni Filippo, Dall'Oglio Luigi, Callea Francesco
Department of Pathology, Children's Hospital Bambino Gesù, Rome, Italy.
Digestion. 2008;77(1):16-9. doi: 10.1159/000114828. Epub 2008 Feb 4.
Esophageal diseases are common in infants and children, and may present with several clinical and pathological aspects. Eosinophilic esophagitis (EE) is characterized by inflammatory, predominantly eosinophilic infiltrate (> or =15 eosinophils per high-power field (HPF)) that is not responsive to acid suppression therapy. An immunoallergic pathogenesis has been hypothesized, likely related to food allergy. Barrett's esophagus (BE) is due to chronic gastroesophageal reflux. The pathological consequence is the replacement of normal stratified squamous epithelium by columnar mucosa with goblet cells.
We present 2 children with a history of food allergy. Endoscopy revealed linear furrows and yellow plaques in the mid-distal esophagus.
In both patients histology showed a high number of eosinophils (>30 at HPF) in the mid-distal esophagus and intestinal metaplasia with goblet cells in distal esophagus. Diagnosis of EE associated to BE was made. Restriction diet was administered to treat EE whereas, in 1 case, laparoscopic fundoplication was performed to treat BE. Follow-up showed a remission of endoscopic and histological aspects.
The unusual, possibly fortuitous association of EE and BE, two conditions differing in etiopathogenesis, clinical and pathological features, calls for a correct diagnosis to offer suitable treatment and prognosis.
食管疾病在婴幼儿和儿童中很常见，可能呈现出多种临床和病理表现。嗜酸性粒细胞性食管炎（EE）的特征是炎症，主要为嗜酸性粒细胞浸润（每高倍视野（HPF）≥15个嗜酸性粒细胞），对抑酸治疗无反应。有人提出免疫过敏发病机制，可能与食物过敏有关。巴雷特食管（BE）是由慢性胃食管反流引起的。病理结果是正常的复层鳞状上皮被含有杯状细胞的柱状黏膜所取代。
我们报告2例有食物过敏史的儿童。内镜检查发现食管中下段有线性沟纹和黄色斑块。
两名患者的组织学检查均显示食管中下段有大量嗜酸性粒细胞（HPF>30个），食管下段有含杯状细胞的肠化生。诊断为EE合并BE。采用限制饮食治疗EE，其中1例采用腹腔镜胃底折叠术治疗BE。随访显示内镜和组织学表现缓解。
EE和BE这两种在病因、临床和病理特征上不同的疾病不寻常的、可能偶然的关联，需要正确诊断以提供合适的治疗和预后。
