Attwood S E, Smyrk T C, Demeester T R, Jones J B
Creighton University School of Medicine, Department of Surgery and Pathology, Omaha, Nebraska 68131.
Dig Dis Sci. 1993 Jan;38(1):109-16. doi: 10.1007/BF01296781.
Small numbers of intraepithelial esophageal eosinophils (IEE) may be seen in 50% of patients with gastroesophageal reflux disease and occasionally in normal volunteers. High concentrations of IEE are rarely seen in either setting. During a two-year period we identified 12 adult patients with very dense eosinophil infiltrates in esophageal biopsies (defined as > 20 IEE/high-power field). Dysphagia was the presenting complaint in each, but no evidence of anatomical obstruction could be found. Endoscopic esophagitis was absent, but biopsy showed marked squamous hyperplasia and many IEE. Eleven patients had normal esophageal acid exposure on 24-hr pH monitoring. Esophageal manometry showed a nonspecific motility disturbance in 10 patients. For comparison, 90 patients with excess esophageal acid exposure on 24-hr pH monitoring were studied. Thirteen (14%) had motility disturbance, and 21 (23%) had dysphagia. Esophageal biopsies were devoid of IEE in 47 patients; none of the 43 with IEE had infiltrates as dense as those seen in the 12 study patients. The presence of high concentrations of IEE in esophageal biopsies from patients with dysphagia, normal endoscopy, and normal 24-hr esophageal pH monitoring represents a distinctive clinicopathologic syndrome not previously described.
在50%的胃食管反流病患者中可发现少量食管上皮内嗜酸性粒细胞（IEE），正常志愿者中偶尔也可见到。在这两种情况下，高浓度的IEE都很少见。在两年时间里，我们确定了12例成年患者，其食管活检显示有非常密集的嗜酸性粒细胞浸润（定义为每高倍视野>20个IEE）。吞咽困难是每位患者的主要症状，但未发现解剖学梗阻的证据。内镜检查未发现食管炎，但活检显示有明显的鳞状上皮增生和许多IEE。11例患者在24小时pH监测中食管酸暴露正常。食管测压显示10例患者有非特异性运动障碍。作为对照，对90例24小时pH监测显示食管酸暴露过多的患者进行了研究。其中13例（14%）有运动障碍，21例（23%）有吞咽困难。47例患者的食管活检未发现IEE；43例有IEE的患者中，没有一例的浸润程度像12例研究患者那样密集。吞咽困难、内镜检查正常且24小时食管pH监测正常的患者食管活检中存在高浓度IEE，这代表了一种以前未描述过的独特临床病理综合征。
