Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Dis Esophagus. 2010 Apr;23(3):191-5. doi: 10.1111/j.1442-2050.2009.01019.x. Epub 2009 Oct 26.
A small percentage of patients who carry the diagnosis of refractory gastroesophageal reflux disease (GERD) actually have eosinophilic esophagitis (EoE). The purpose of this study was to describe a series of patients who underwent fundoplication for presumed refractory GERD, but subsequently were found to have EoE. We performed a retrospective analysis of our EoE database. Patients diagnosed with EoE after Nissen were identified. Cases were defined according to recent consensus guidelines. Five patients underwent anti-reflux surgery for refractory GERD, but were subsequently diagnosed with EoE. None had esophageal biopsies prior to surgery, and in all subjects, symptoms persisted afterward, with no evidence of wrap failure. The diagnosis of EoE was typically delayed (range: 3-14 years), and when made, there were high levels of esophageal eosinophilia (range: 30-170 eos/hpf). A proportion of patients undergoing fundoplication for incomplete resolution of GERD symptoms will be undiagnosed cases of EoE. Given the rising prevalence of EoE, we recommend obtaining proximal and distal esophageal biopsies in such patients prior to performing anti-reflux surgery.
一小部分被诊断为难治性胃食管反流病（GERD）的患者实际上患有嗜酸性食管炎（EoE）。本研究的目的是描述一组接受抗反流手术治疗疑似难治性 GERD 的患者，但随后被发现患有 EoE。我们对我们的 EoE 数据库进行了回顾性分析。确定了在 Nissen 手术后被诊断为 EoE 的患者。根据最近的共识指南定义了病例。五名患者因难治性 GERD 接受了抗反流手术，但随后被诊断为 EoE。这些患者在手术前均未进行食管活检，并且在所有患者中，症状持续存在，没有包裹失败的证据。EoE 的诊断通常被延迟（范围：3-14 年），当做出诊断时，食管嗜酸性粒细胞增多症的水平较高（范围：30-170 个 eos/hpf）。在接受抗反流手术治疗 GERD 症状不完全缓解的患者中，有一部分是未确诊的 EoE 病例。鉴于 EoE 的患病率不断上升，我们建议在进行抗反流手术之前，对这些患者进行近端和远端食管活检。
