好酸球性胃腸炎の1例

Eosinophilic Gastroenteritis, Report of a Case

要旨　患者は20歳の男性で，当科受診の1年3か月以前に他院で小腸切除術を受け，病理学的検索で好酸球性胃腸炎と診断された．今回，上腹部痛，悪心，嘔吐，下痢を主訴に当科受診，血液検査では末梢血好酸球および血清IgEの増加を伴っていた．上部消化管X線検査と内視鏡検査では，胃前庭部および十二指腸第2部の浮腫による伸展不良がみられた．また小腸X線検査では，上部小腸の伸展不良，中～下部小腸の管腔狭小化が認められた．入院後，かゆ食，輸液により症状は軽減し，副腎皮質ステロイド投与により血液検査も速やかに正常化した．また，X線上の異常も改善を示した．退院後，再度症状の出現をみたが，副腎皮質ステロイド投与により速やかに消失した．

　A 20-year-old man was admitted to our hospital on December 9, 1982 with complaints of upper abdominal pain, nausea, vomiting and diarrhea. He had been operated on because of a lesion of the jejunum on September 3, 1981 with resultant histological diagnosis being eosinophilic gastroenteritis (Fig. 1). Examination of the blood disclosed 14,900 white blood cells with 59％ eosinophils.

　Upper gastrointestinal series revealed narrowing of the gastric antrum and the second portion of the duodenum. Endoscopy showed edematous mucosa of the prepyloric area, and severe swelling and reddening of the Kerckring's folds in the second portion of the duodenum. Double contrast study of the small intestine demonstrated decreased distensibility in a longitudinal direction, and Kerckring's folds were dense in the upper portion. Double contrast study of the small intestine also showed narrowing of the lumen and Kerckring's folds were wide by edema in the middle to the lower portion (Figs. 5 and 6).

　Soft diet and intravenous hydration were effective in eliminating subjective symptoms. Oral prednisolone administration was also effective for eosinophilia. After discharge, he came again to our hospital with the same complaints. He was again treated with prednisolone and recovered rapidly.