食道炎症性疾患における内視鏡診断の最前線

Frontiers of Endoscopic Diagnosis in Inflammatory Disorders of the Esophagus

要旨●食道炎症性疾患は多様な病態を背景とし，疾患によっては類似した内視鏡所見を呈するため，日常診療において診断に迷うことは少なくない．内視鏡機器の進歩により詳細な観察が可能となったが，得られる所見は必ずしも疾患特異的ではない．食道炎症性疾患の診断に際しては内視鏡所見のみでなく，臨床情報や生検病理組織学的評価を含めた総合的判断が求められる．本稿では，逆流性食道炎，好酸球性食道炎，リンパ球性食道炎，食道扁平苔癬，epidermoid metaplasia，移植片対宿主病（GVHD）を取り上げ，内視鏡所見の特徴と鑑別の要点を整理する．また，好酸球性食道炎やリンパ球性食道炎との鑑別が必要な食道カンジダ症についても併せて概説する．

　Inflammatory disorders of the esophagus arise from a broad range of underlying conditions, and their endoscopic findings often overlap, making diagnosis challenging in routine clinical practice. Although advances in endoscopic technology have enabled more detailed mucosal assessment, the resulting findings are not always disease-specific. Therefore, the diagnosis of esophageal inflammatory disorders should not rely solely on endoscopic appearance but should instead be based on a comprehensive evaluation that integrates clinical information and histopathological analysis of biopsy specimens. This article reviews reflux esophagitis, eosinophilic esophagitis, lymphocytic esophagitis, esophageal lichen planus, epidermoid metaplasia, and graft-versus-host disease, with emphasis on their characteristic endoscopic features and key points in differential diagnosis. It also outlines esophageal candidiasis, which should be considered in the differential diagnosis of eosinophilic and lymphocytic esophagitis.