Frieling Thomas, Heise Jürgen, Kreysel Christian, Blank Michael, Hemmerlein Bernhard, Beccu Lothar, Kuhlbusch-Zicklam Rita
Medizinische Klinik II, HELIOS Klinikum Krefeld, Germany.
Institut für Pathologie, HELIOS Klinikum Krefeld, Germany.
Z Gastroenterol. 2019 Feb;57(2):151-155. doi: 10.1055/a-0808-5043. Epub 2019 Feb 12.
Eosinophilic esophagitis (EoE) is detected frequently in dysphagia and noncardiac chest pain. Management of patients with EoE may be complicated because EoE is associated frequently with esophageal motility disorders. We present the rare case of esophageal achalasia (EA) associated with eosinophilic infiltration and a literature review.
A patient with dysphagia and eosinophilic infiltration referred to our clinic underwent standardized diagnostic work-up including symptom questionnaire, esophagogastroduodenoscopy (EGD) with esophageal biopsies, barium swallow, high-resolution esophageal manometry, and combined intraluminal 24-hour pH-impedance testing (pH/MII).
The patient had an Eckardt score of 8. EGD and mucosal biopsies showed typical EoE with > 15 eosinophil leucocytes per high-power field. Barium swallow revealed typical sign of achalasia. HREM indicated EA type 2 according to the Chicago classification. PH/MII was normal. Oral and systemic corticoid therapy were without effect. After successful treatment by pneumatic dilation of the cardia, symptoms relieved and eosinophilic infiltration returned to normal.
The results suggest that the patient had primary EA associated with eosinophilic infiltration and that the combined occurrence of these rare diseases is not just a coincidence.
嗜酸性粒细胞性食管炎（EoE）在吞咽困难和非心源性胸痛患者中经常被检测到。EoE患者的管理可能很复杂，因为EoE经常与食管动力障碍相关。我们报告了一例罕见的伴有嗜酸性粒细胞浸润的食管贲门失弛缓症（EA）病例并进行文献复习。
一名因吞咽困难和嗜酸性粒细胞浸润前来我院就诊的患者接受了标准化的诊断检查，包括症状问卷、食管胃十二指肠镜检查（EGD）及食管活检、吞钡检查、高分辨率食管测压以及联合腔内24小时pH阻抗测试（pH/MII）。
该患者的埃卡德特评分为8分。EGD及黏膜活检显示典型的EoE，每高倍视野嗜酸性粒细胞白细胞>15个。吞钡检查显示典型的贲门失弛缓症征象。高分辨率食管测压根据芝加哥分类法提示为2型EA。pH/MII正常。口服及全身皮质类固醇治疗无效。贲门气囊扩张成功治疗后，症状缓解，嗜酸性粒细胞浸润恢复正常。
结果表明该患者患有与嗜酸性粒细胞浸润相关的原发性EA，且这两种罕见疾病的合并发生并非巧合。
