食道炎の内視鏡診断―好酸球性食道炎

Endoscopic Diagnosis of Esophagitis: Eosinophilic Esophagitis

要旨　好酸球性食道炎は空中の真菌や食物が抗原となって食道に起こるアレルギー性の慢性疾患で，嚥下障害や胸やけなどの症状を引き起こす．内視鏡検査では食道粘膜に白斑，縦走溝，多発輪状狭窄，発赤などの異常が発見されることが多いが，1/4の例で内視鏡像に異常を見い出すことができない．そこで，食道に起因すると考えられる慢性症状を有する例では内視鏡検査で異常がなくても食道粘膜の生検を行って，上皮内に多数の好酸球の浸潤がないか病理組織学的な検討を行うことが必要である．

　Eosinophilic esophagitis is a chronic allergic disease aggravated by inhalated fungal antigens and food antigens. Patients with this disease report various esophagus related symptoms such as dysplasia and heartburn. Endoscopic examination frequently detects esophageal mucosal white stippled-like exudates, linear fissures, reddening, rings, and other mucosal changes. In one fourth of the investigated cases, however, no abnormality can be found even by endoscopy. Therefore, when patients report chronic symptoms possibly related to the esophageal diseases, endoscopic biopsies and histo-pathological examination of the esophageal mucosa should be seriously considered even in the absence of endoscopically-identified abnormalities.