Ahn Byungkyu, Lee Dong Ho, Lee Chang Min, Hwang Jae Jin, Yoon Hyuk, Shin Cheol Min, Park Young Soo, Kim Nayoung
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2016 Apr 25;67(4):178-82. doi: 10.4166/kjg.2016.67.4.178.
BACKGROUND/AIMS: Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease, with eosinophilic infiltration limited to the esophagus. A minority of EoE patients respond well to proton pump inhibitor (PPI) therapy alone, and that condition is labelled PPI-responsive esophageal eosinophilia (PPI-REE). The prevalence of PPI-REE among EoE cases is unknown. We aimed to identify clinical manifestations of PPI-REE, and the proportion of PPI-REE among all EoE cases.
We reviewed pathology of the 4,075 patients who underwent esophageal biopsy at an institution from March 2003 to July 2015. EoE was diagnosed based on esophageal symptoms and eosinophilic infiltration limited to the esophagus, with ≥15 eosinophils per high-power field. We collected endoscopic and pathologic findings, and clinical features for these patients.
Thirteen (0.3%) patients were diagnosed with EoE. Clinical manifestations were dysphagia (30.8%), foreign body sensation (23.1%), regurgitation (23.1%), cough (15.4%), heartburn (15.4%), nausea (7.7%), dyspepsia (7.7%). The endoscopic findings noted were polypoid lesion (23.1%), whitish plaque or exudate (23.1%), linear furrow (7.7%), concentric ring (7.7%), nodularity (7.7%), erosion (7.7%), and normal (30.8%). Of these patients, five had a favorable course with PPI as monotherapy.
The proportion of EoE among all patients undergoing endoscopic biopsy was 0.3%. Of those, PPI-REE comprised 38%. Most of the endoscopic findings were atypical or normal when compared to the typical findings in EoE. In conclusion, patients who present with symptoms related to esophageal dysfunction need esophageal biopsy, regardless of the endoscopic findings. Moreover, patients diagnosed with EoE need to be treated first with PPI alone.
背景/目的：嗜酸性粒细胞性食管炎（EoE）是一种慢性、免疫/抗原介导的食管疾病，嗜酸性粒细胞浸润局限于食管。少数EoE患者单独使用质子泵抑制剂（PPI）治疗效果良好，这种情况被称为PPI反应性食管嗜酸性粒细胞增多症（PPI-REE）。EoE病例中PPI-REE的患病率尚不清楚。我们旨在确定PPI-REE的临床表现，以及所有EoE病例中PPI-REE的比例。
我们回顾了2003年3月至2015年7月在一家机构接受食管活检的4075例患者的病理情况。根据食管症状和嗜酸性粒细胞浸润局限于食管（每高倍视野≥15个嗜酸性粒细胞）诊断EoE。我们收集了这些患者的内镜和病理检查结果以及临床特征。
13例（0.3%）患者被诊断为EoE。临床表现为吞咽困难（30.8%）、异物感（23.1%）、反流（23.1%）、咳嗽（15.4%）、烧心（15.4%）、恶心（7.7%）、消化不良（7.7%）。内镜检查发现为息肉样病变（23.1%）、白色斑块或渗出物（23.1%）、线性沟（7.7%）、同心圆（7.7%）、结节状（7.7%）、糜烂（7.7%）和正常（30.8%）。在这些患者中，5例单独使用PPI治疗效果良好。
在所有接受内镜活检的患者中，EoE的比例为0.3%。其中，PPI-REE占38%。与EoE的典型表现相比，大多数内镜检查结果不典型或正常。总之，出现食管功能障碍相关症状的患者需要进行食管活检，无论内镜检查结果如何。此外，诊断为EoE的患者首先需要单独使用PPI治疗。
