成人原发性嗜酸性粒细胞性食管炎的诊断：被忽视还是被误解？

The diagnosis of primary eosinophilic oesophagitis in adults: missed or misinterpreted?

机构信息

Department of Surgery, Northumbria Healthcare NHS Foundation Trust, North Tyneside Hospital, North Shields, UK.

出版信息

Eur J Gastroenterol Hepatol. 2010 Jul;22(7):848-55. doi: 10.1097/MEG.0b013e32832c7709.

DOI:10.1097/MEG.0b013e32832c7709

PMID:20453656

Abstract

AIM

The diagnosis of adult eosinophilic oesophagitis (EOE) is rarely made in the UK despite projections of high frequency and prevalence within Western society. This study aimed to identify the frequency of diagnosis of EOE in our community, and to establish reasons for diagnostic failure or delay.

METHODS

The pathology records of all gastroscopies performed (67 840) in Northumbria NHS trust during the years January 2001-November 2008 were reviewed for oesophageal eosinophilia. Case notes and investigations were then inspected to identify patients with a diagnosis of EOE in accordance with American Gastroenterology Association guidelines.

RESULTS

In total, 37 patients fulfilled diagnostic criteria for EOE. The mean duration of symptoms before the diagnosis was 4 years (range 4 months-30 years) and 14 patients (38%) remained undiagnosed until the time of study. Reasons for diagnostic failure and delay included: delayed request for endoscopy in patients with dysphagia (49%, n=18 of 37); poor recognition of typical endoscopic appearances of EOE (16%, n=6 of 37); clinical mislabelling as gastro-oesophageal reflux disease (22%, n=8 of 37) and candida (13%, n=5 of 37); histological mislabelling as gastro-oesophageal reflux disease (19%, n=7 of 37), candida (5%, n=2 of 37), 'inflammation' (8%, n=3 of 37) and Barrett's oesophagus (3%, n=1 of 37); failed recognition or recording of maximal eosinophil concentrations within biopsies (35%, n=13 of 37). In 40% (n=15 of 37) of patients the decision to biopsy was based solely on a dysphagia protocol introduced in 2004. No cases were identified before the protocol implementation.

CONCLUSION

EOE is underdiagnosed in our community owing to lack of clinical suspicion, failure to biopsy, and histopathological misinterpretation. Educating clinicians and pathologists before planning an endoscopy may improve the diagnostic sensitivity.

摘要

目的

尽管在西方社会中，成人嗜酸性食管炎（EOE）的发病率和患病率预计很高，但在英国，这种疾病的诊断却很少见。本研究旨在确定我们社区中 EOE 的诊断频率，并确定诊断失败或延迟的原因。

方法

回顾了 2001 年 1 月至 2008 年 11 月期间诺森比亚国民保健信托基金（Northumbria NHS trust）进行的所有胃镜检查（67840 例）的病理学记录，以寻找食管嗜酸性粒细胞增多症。然后检查病历和检查结果，以根据美国胃肠病学协会的指南确定符合 EOE 诊断标准的患者。

结果

共有 37 名患者符合 EOE 的诊断标准。从症状出现到诊断的平均时间为 4 年（4 个月至 30 年），14 名患者（38%）直到研究时仍未被诊断。诊断失败和延迟的原因包括：吞咽困难患者的内镜检查请求延迟（49%，37 例中的 18 例）；对 EOE 的典型内镜表现认识不足（16%，37 例中的 6 例）；临床误诊为胃食管反流病（22%，37 例中的 8 例）和念珠菌病（13%，37 例中的 5 例）；组织学误诊为胃食管反流病（19%，37 例中的 7 例）、念珠菌病（5%，37 例中的 2 例）、“炎症”（8%，37 例中的 3 例）和 Barrett 食管（3%，37 例中的 1 例）；未能识别或记录活检中嗜酸性粒细胞的最高浓度（35%，37 例中的 13 例）。在 40%（37 例中的 15 例）的患者中，活检的决定仅基于 2004 年引入的吞咽困难方案。在该方案实施之前，没有发现病例。