好酸球性食道炎の1例

Eosinophlic Esophagitis, Report of a Case

要旨　患者は44歳，男性．PPI抵抗性の逆流性食道炎として治療中，内視鏡検査で胸部食道に畳目模様より幅が広く増強した輪状溝，短い縦走溝，微細な白斑，白濁肥厚した粗糙粘膜を認めた．NBI拡大観察では血管密度が減少していた．食道の複数の生検で高度な好酸球浸潤を認め，好酸球性食道炎と診断した．ステロイドの吸入療法後内視鏡所見は改善し，生検でも好酸球の浸潤の消失を確認した．本症は嚥下困難やGERD類似症状を呈するが，認知度が低く，逆流性食道炎として治療されている症例もあると思われる．本症を疑ったら複数か所の生検を行うべきである．

　A 44-year-old man had been treated with PPI（proton pump inhibitor）under diagnosis of reflux esophagitis, but mild dysphagia had continued. Follow-up upper gastrointestinal endoscopy revealed mucosal rings, linear furrows, loss of vascularity, and whitish exudates in a granular pattern. NBI（narrow band imaging）magnifying endoscopy revealed decreased IPCL（intra-epithelial papillary capillary loop）. The patient was diagnosed as EE（eosinophilic esophagitis）based on biopsy specimens showing marked esophageal eosinophilia. After treatment of inhaled steroid, endoscopic findings were improved and esophageal eosinophilia disappeared pathologically. EE which have similar symptoms to GERD（gastroesophageal reflux disease）is not well recognized among endoscopists yet. EE may be confused with GERD which is refractory to PPI. Endoscopists must become aware of EE and biopsy specimen should be obtained from different esophageal locations along the length when EE is suspected.