Ishimura Norihisa, Sumi Shohei, Okada Mayumi, Izumi Daisuke, Mikami Hironobu, Okimoto Eiko, Ishikawa Nahoko, Tamagawa Yuji, Mishiro Tsuyoshi, Oshima Naoki, Shibagaki Kotaro, Ishihara Shunji, Maruyama Riruke, Kinoshita Yoshikazu
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan.
Department of Pathology, Shimane University School of Medicine, Izumo, Japan.
Endosc Int Open. 2018 Feb;6(2):E165-E172. doi: 10.1055/s-0043-122882. Epub 2018 Feb 1.
Characteristic endoscopic findings, such as linear furrows, rings, and whitish exudates, indicate the presence of esophageal eosinophilia (EE), though no specific findings are known to distinguish eosinophilic esophagitis (EoE) from proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE). Here, we present a novel endoscopic finding in some EE patients possessing a linear longitudinal arrangement of whitish nodules with the appearance of the back of an Ankylosaurus dinosaur, termed Ankylosaurus back sign (ABS), and evaluations of its significance in affected patients.
Fifty-five patients diagnosed with EE (≥ 15 eosinophils/high power field) who were treated at our hospital and shown to evaluate a PPI response were enrolled. Endoscopic findings at baseline and clinical parameters were retrospectively reviewed. Furthermore, the clinicopathological features of patients with ABS, as well as the relationship between its presence and PPI response were evaluated.
Fifty-five patients (47 males, 8 females) with EE (17 with EoE, 38 with PPI-REE) were evaluated, of whom 50 (90.9 %) had linear furrows, the most frequently found feature, while ABS was found in 9 (16.4 %). Inter-observer agreement was substantial for ABS (κ 0.77). Interestingly, all patients with ABS had PPI-REE. Our findings revealed that the presence of ABS was closely associated with reflux esophagitis (RE) in patients with PPI-REE.
Although ABS was less frequent than typical endoscopic findings such as linear furrows in EE, this novel finding was closely associated with PPI-REE accompanied with RE. The clinical implications of ABS in patients with EE should be investigated further.
特征性内镜表现，如线性沟纹、环和白色渗出物，提示食管嗜酸性粒细胞增多（EE），但尚无已知的特异性表现可区分嗜酸性食管炎（EoE）与质子泵抑制剂反应性食管嗜酸性粒细胞增多（PPI-REE）。在此，我们报告了一些EE患者出现的一种新的内镜表现，即白色结节呈线性纵向排列，形似甲龙的背部，称为甲龙背征（ABS），并对其在受累患者中的意义进行了评估。
纳入55例在我院接受治疗并评估PPI反应的诊断为EE（≥15个嗜酸性粒细胞/高倍视野）的患者。回顾性分析基线时的内镜表现和临床参数。此外，评估了具有ABS患者的临床病理特征及其与PPI反应的关系。
评估了55例EE患者（47例男性，8例女性）（17例EoE，38例PPI-REE），其中50例（90.9%）有线性沟纹，这是最常见的特征，而9例（16.4%）有ABS。观察者间对ABS 的一致性较高（κ=0.77）。有趣的是，所有有ABS的患者均为PPI-REE。我们的研究结果显示，PPI-REE患者中ABS的存在与反流性食管炎（RE）密切相关。
虽然ABS在EE中比典型的内镜表现如线性沟纹少见，但这一新发现与伴有RE的PPI-REE密切相关。EE患者中ABS的临床意义应进一步研究。
