Jackson Whitney E, Mehendiratta Vaibhav, Palazzo Juan, Dimarino Anthony J, Quirk Daniel M, Cohen Sidney
Departments of Internal Medicine (Whitney E. Jackson).
Gastroenterology and Hepatology (Vaibhav Mehendiratta, Anthony J. DiMarino, Daniel M. Quirk, Sidney Cohen).
Ann Gastroenterol. 2013;26(2):166-169.
Prior studies report esophageal rupture following endoscopy or bolus impaction in eosinophilic esophagitis (EoE). The purpose of this study is to add new information to available evidence defining the clinical spectrum of spontaneous rupture (Boerhaave's syndrome) associated with vomiting in EoE.
A retrospective search of inpatient and outpatient records was conducted from January 2001 to January 2011. A faculty member in pathology blindly reviewed all esophageal biopsy specimens. EoE was defined as 15 or more eosinophils in at least 2 high-power fields (hpfs) or 25 or more eosinophils in any single HPF.
In ten years, 447 patients were identified with a diagnosis of EoE. Of these, four patients presented with Boerhaave's syndrome in the setting of EoE. None of the patients had an established diagnosis of EoE prior to presentation. All cases presented with a triad of vomiting, chest pain and pneumomediastinum. In two patients, water-soluble contrast extravasation prompted surgical intervention (50%). Full thickness surgical specimen provides a unique opportunity to show eosinophils in the muscularis propria. Intraepithelial eosinophil infiltration was seen on all mucosal biopsies (>25/hpf) with significant improvement after steroid (topical or systemic) treatment.
Spontaneous esophageal rupture is a rare (4/447, less than 1%) but critical presentation of EoE manifesting with vomiting, chest pain and pneumomediastinum. Surgery is required if extravasation is seen with water-soluble contrast. We suggest that EoE may be a transmural disease in some patients, thus making the esophageal wall susceptible to spontaneous rupture with vomiting (Boerhaave's syndrome).
既往研究报道了嗜酸性食管炎（EoE）患者在内镜检查或食团嵌塞后发生食管破裂。本研究的目的是为现有证据增添新信息，以明确与EoE呕吐相关的自发性破裂（Boerhaave综合征）的临床谱。
对2001年1月至2011年1月期间的住院和门诊记录进行回顾性检索。一名病理科教员对所有食管活检标本进行盲法审查。EoE定义为至少2个高倍视野（hpf）中有15个或更多嗜酸性粒细胞，或任何单个高倍视野中有25个或更多嗜酸性粒细胞。
在十年间，共确诊447例EoE患者。其中，4例患者在EoE背景下出现Boerhaave综合征。所有患者在出现症状前均未确诊EoE。所有病例均表现为呕吐、胸痛和气纵隔三联征。2例患者出现水溶性造影剂外渗，促使进行手术干预（50%）。全层手术标本提供了一个独特的机会来显示固有肌层中的嗜酸性粒细胞。所有黏膜活检均可见上皮内嗜酸性粒细胞浸润（>25/hpf），经类固醇（局部或全身）治疗后有显著改善。
自发性食管破裂是EoE一种罕见（4/447，小于1%）但严重的表现，表现为呕吐、胸痛和气纵隔。如果出现水溶性造影剂外渗，则需要进行手术。我们认为，在某些患者中EoE可能是一种透壁性疾病，因此使食管壁在呕吐时易发生自发性破裂（Boerhaave综合征）。
