Vaz Ana Margarida, Cadilla Antonio Jesus, Sousa Diamantino, Guerreiro Horácio
Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal.
Histopathology Department, Centro Hospitalar do Algarve, Faro, Portugal.
BMJ Case Rep. 2017 Nov 9;2017:bcr-2017-222405. doi: 10.1136/bcr-2017-222405.
A 25-year-old man was seen in outpatient clinic for progressive solid food dysphagia. He was already medicated with a proton pump inhibitor with no improvement. His blood tests showed a slight microcytic anaemia and peripheral eosinophilia. The oesophago-gastro-duodenoscopy showed longitudinal furrows in the distal two-thirds of the oesophagus and a concentric distal stenosis. The biopsies taken showed eosinophilic infiltrates consistent with eosinophilic oesophagitis. There was no improvement with topical fluticasone, so the patient was started on a systemic corticosteroid with resolution of dysphagia and of the oesophageal stenosis. He was kept on topical steroids for symptomatic control. On repeat endoscopy, the duodenal mucosa showed multiple papules that were biopsied. Histology showed features consistent with coeliacdisease. The patient was asymptomatic but there was evidence of iron deficiency anaemia, and so a gluten-free diet was started. Despite only a partial adherence to the diet, the iron deficiency anaemia resolved.
一名25岁男性因进行性固体食物吞咽困难到门诊就诊。他已经服用质子泵抑制剂，但症状并无改善。血液检查显示轻度小细胞贫血和外周嗜酸性粒细胞增多。食管胃十二指肠镜检查显示食管远端三分之二有纵向皱襞和同心性远端狭窄。活检显示嗜酸性粒细胞浸润，符合嗜酸性食管炎。局部使用氟替卡松无效，因此患者开始使用全身性皮质类固醇，吞咽困难和食管狭窄得以缓解。为控制症状，他继续使用局部类固醇。再次内镜检查时，十二指肠黏膜有多个丘疹，遂取组织活检。组织学显示符合乳糜泻的特征。患者无症状，但有缺铁性贫血的证据，因此开始采用无麸质饮食。尽管患者只是部分坚持该饮食，但缺铁性贫血仍得以缓解。
