Heerasing Neel, Lee Shok Yin, Alexander Sina, Dowling Damian
Neel Heerasing, Department of Gastroenterology, Alfred Hospital, Melbourne, VIC 3004, Australia.
World J Gastrointest Pharmacol Ther. 2015 Nov 6;6(4):244-7. doi: 10.4292/wjgpt.v6.i4.244.
To look at the relationship between eosinophilic oesophagitis (EO) and food bolus impaction in adults.
We retrospectively analysed medical records of 100 consecutive patients who presented to our hospital with oesophageal food bolus obstruction (FBO) between 2012 and 2014. In this cohort, 96 were adults (64% male), and 4 paediatric patients were excluded from the analysis as our centre did not have paediatric gastroenterologists. Eighty-five adult patients underwent emergency gastroscopy. The food bolus was either advanced into the stomach using the push technique or retrieved using a standard retrieval net. Biopsies were obtained in 51 patients from the proximal and distal parts of the oesophagus at initial gastroscopy. All biopsy specimens were assessed and reviewed by dedicated gastrointestinal pathologists at the Department of Pathology, University Hospital Geelong. The diagnosis of EO was defined and established by the presence of the following histological features: (1) peak eosinophil counts > 20/hpf; (2) eosinophil microabscess; (3) superficial layering of eosinophils; (4) extracellular eosinophil granules; (5) basal cell hyperplasia; (6) dilated intercellular spaces; and (7) subepithelial or lamina propria fibrosis. The histology results of the biopsy specimens were accessed from the pathology database of the hospital and recorded for analysis.
Our cohort had a median age of 60. Seventeen/51 (33%) patients had evidence of EO on biopsy findings. The majority of patients with EO were male (71%). Classical endoscopic features of oesophageal rings, furrows or white plaques and exudates were found in 59% of patients with EO. Previous episodes of FBO were present in 12/17 patients and 41% had a history of eczema, hay fever or asthma. Reflux oesophagitis and benign strictures were found in 20/34 patients who did not have biopsies.
EO is present in approximately one third of patients who are admitted with FBO. Biopsies should be performed routinely at index endoscopy in order to pursue this treatable cause of long term morbidity.
研究成人嗜酸性粒细胞性食管炎（EO）与食物团块嵌塞之间的关系。
我们回顾性分析了2012年至2014年间因食管食物团块梗阻（FBO）就诊于我院的100例连续患者的病历。在该队列中，96例为成人（64%为男性），4例儿科患者被排除在分析之外，因为我们中心没有儿科胃肠病学家。85例成年患者接受了急诊胃镜检查。食物团块要么通过推送技术推进胃内，要么使用标准的回收网取出。51例患者在初次胃镜检查时从食管近端和远端获取了活检标本。所有活检标本均由吉朗大学医院病理科专门的胃肠病理学家进行评估和复查。EO的诊断通过以下组织学特征来定义和确立：（1）嗜酸性粒细胞峰值计数>20/hpf；（2）嗜酸性粒细胞微脓肿；（3）嗜酸性粒细胞浅表分层；（4）细胞外嗜酸性粒细胞颗粒；（5）基底细胞增生；（6）细胞间隙增宽；（7）上皮下或固有层纤维化。活检标本的组织学结果从医院病理数据库中获取并记录用于分析。
我们的队列中位年龄为60岁。17/51（33%）的患者活检结果显示有EO证据。大多数EO患者为男性（71%）。59%的EO患者有食管环、沟或白色斑块及渗出物等典型内镜特征。12/17的患者有既往FBO发作史，41%有湿疹、花粉症或哮喘病史。在未进行活检的34例患者中，发现20例有反流性食管炎和良性狭窄。
因FBO入院的患者中约三分之一存在EO。应在首次内镜检查时常规进行活检，以探寻这种可治疗的长期发病原因。
