Yamabe Akane, Irisawa Atsushi, Shibukawa Goro, Abe Yoko, Saito Akiko, Imbe Koh, Hoshi Koki, Igarashi Ryo
Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2 Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
Clin J Gastroenterol. 2014 Aug;7(4):305-9. doi: 10.1007/s12328-014-0504-4. Epub 2014 Jun 27.
A 50-year-old woman was referred to our hospital for dysphagia and several episodes of esophageal food impaction during the prior three months. Complete blood count and basic biochemical tests were normal. No eosinophilia was found. Esophagogastroduodenoscopy (EGD) revealed the presence of concentric rings (esophageal "trachealization") and stenosis along the middle and distal esophagus. Endoscopic ultrasound (EUS) showed circumferential thickening of all layers in the same part. Cytopathologic evaluation of a specimen obtained by endoscopic biopsy of the thickened area in the distal esophagus showed eosinophilic infiltration (20 eosinophils per high-powered field). She was diagnosed as having eosinophilic esophagitis (EoE). Topical steroid therapy was started. A tendency of dysphagia for relief and improvement of characteristic EGD findings began early, but wall thickening in EUS remained. Past reports of the related literature have described that thickness of submucosa and muscularis propria remained after therapy, although significant reduction in the mucosal thickness was provided by short-term steroid therapy. One explanation for early relapse is insufficient reduction in the submucosa and muscularis propria. Consequently, our patient was given steroids until thickness on EUS improved. EUS is regarded as useful for evaluating the curative effect in patients with EoE.
一名50岁女性因吞咽困难以及在过去三个月内发生数次食管食物嵌塞而转诊至我院。全血细胞计数和基本生化检查均正常。未发现嗜酸性粒细胞增多。食管胃十二指肠镜检查（EGD）显示食管中下段存在同心圆状环（食管“气管化”）及狭窄。内镜超声（EUS）显示同一部位各层均有环形增厚。对远端食管增厚区域进行内镜活检所取标本的细胞病理学评估显示有嗜酸性粒细胞浸润（每高倍视野20个嗜酸性粒细胞）。她被诊断为嗜酸性食管炎（EoE）。开始局部类固醇治疗。吞咽困难缓解以及EGD特征性表现改善的趋势出现较早，但EUS显示的管壁增厚依然存在。相关文献既往报道称，尽管短期类固醇治疗可使黏膜厚度显著减小，但治疗后黏膜下层和固有肌层的厚度仍会留存。早期复发的一个原因是黏膜下层和固有肌层的减小不充分。因此，我们的患者持续使用类固醇，直至EUS显示的厚度有所改善。EUS被认为对评估EoE患者的治疗效果有用。
