好酸球性食道炎の1例

Esosinophilic Esophagitis, Report of a Case

要旨　患者は51歳，男性．主訴は嚥下困難．検診の内視鏡検査で食道の異常所見を指摘され，当科へ紹介された．食道X線造影検査で食道壁の伸展は良好で，食道粘膜に縦走する線状の淡いバリウム斑を認めた．上部消化管内視鏡検査で食道は全体的に白濁肥厚した粗糙粘膜を呈し，血管透見は消失し，食道全体に数条の長軸に縦走する溝を認めた．食道壁の収縮により縦走溝は明瞭となり，通常の畳目模様より幅の広い輪状溝と敷石様変化を認めた．食道粘膜生検の病理組織検査は食道粘膜上皮に好酸球浸潤（＞20/HPF）を認め，好酸球性食道炎と診断した．プロトンポンプ阻害薬は無効であったが，プレドニゾロンの投与により症状は消失し内視鏡所見も改善した．

　A 51-year-old man was referred to our department because of dysphagia and esophageal abnormality detected by upper gastrointestinal endoscopy for screening. Esophagogram revealed linear and light barium spots in the middle portion of the esophagus, with normal extension of the esophagus wall. Upper gastrointestinal endoscopy revealed whitish rough mucosa, loss of vascularity, linear furrows, mucosal ring, and cobblestone like appearance. Histologic examination of the esophageal biopsy specimen revealed marked eosinophil infiltration of the mucosa（more than 20 eosinophils per high-power field, HPF 400×）. The patient was diagnosed as EE（eosinophilic esophagitis）based on biopsy specimens showing marked esophageal eosinophilia. He had been prescribed an oral proton-pump inhibitor, but his symptoms had not improved. After treatment using oral prednisolone（20mg/day）, endoscopic findings showed improvement and esophageal pathological eosinophilia disappeared.