Igarashi Ryo, Irisawa Atsushi, Shibukawa Goro, Yamabe Akane, Fujisawa Mariko, Sato Ai, Maki Takumi, Arakawa Noriyuki, Yoshida Yoshitsugu, Yamamoto Shogo, Ikeda Tsunehiko
Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
Clin J Gastroenterol. 2016 Oct;9(5):285-8. doi: 10.1007/s12328-016-0678-z. Epub 2016 Aug 9.
Eosinophilic esophagitis (EoE) is diagnosed by microscopic findings of eosinophilic infiltration into the squamous epithelium. In contrast, another disease concept termed "eosinophilic esophageal myositis (EoEM)" has been proposed, whereby there is eosinophilic infiltration into the muscularis propria instead. A 60-year-old man was referred to our hospital for chest pain, dysphagia, and several episodes of esophageal food impaction. Although EoE was suspected based on clinical features, biopsy specimens showed no mucosal eosinophilic infiltration. Endoscopic ultrasound (EUS) showed thickening of the muscularis propria layer and subsequent EUS-guided fine-needle aspiration biopsy (EUS-FNA) revealed eosinophilic infiltration into the muscularis propria. Although the patient's symptoms gradually improved after steroid administration, complete remission was not achieved after 1 year of treatment. This case may reflect a disorder distinct from typical EoE based on eosinophilic infiltration of the muscularis propria but not the squamous epithelium, and we, therefore, diagnosed it as EoEM using the EUS-FNA findings as reference.
嗜酸性粒细胞性食管炎（EoE）通过鳞状上皮嗜酸性粒细胞浸润的微观表现来诊断。相比之下，另一种疾病概念“嗜酸性粒细胞性食管肌炎（EoEM）”已被提出，即嗜酸性粒细胞浸润到固有肌层。一名60岁男性因胸痛、吞咽困难和数次食管食物嵌塞发作被转诊至我院。尽管根据临床特征怀疑为EoE，但活检标本未显示黏膜嗜酸性粒细胞浸润。内镜超声（EUS）显示固有肌层增厚，随后的EUS引导下细针穿刺活检（EUS-FNA）显示嗜酸性粒细胞浸润到固有肌层。尽管患者在使用类固醇治疗后症状逐渐改善，但治疗1年后未实现完全缓解。该病例可能反映了一种与典型EoE不同的疾病，其基于固有肌层而非鳞状上皮的嗜酸性粒细胞浸润，因此，我们以EUS-FNA结果为参考将其诊断为EoEM。
