剝離性食道炎の1例

Exfoliative Esophagitis, Report of a Case

　急性食道炎は近年内視鏡の進歩・普及に伴い，発見の頻度が高まっている．剝離性食道炎は急性食道炎に分類されるまれな食道炎で，嚥下痛と食道粘膜上皮が筒状に剝離し，喀出されることを特徴とするが，近年報告例はほとんどない¹⁾²⁾．最近われわれは肺癌患者で経過中に剝離性食道炎を起こした症例を経験したので報告する．

　症　例

　患　者：64歳，女性，主婦．

　主　訴：嚥下痛．

　家族歴：父方祖父母，父母，兄が脳卒中にて死亡．

　既往歴：38歳ごろより高血圧．（タバコ，酒(－)）

　現病歴：1982年3月ごろより咳嗽出現．同年7月胸部異常陰影を指摘され，当科外来受診し，生検にてmoderately differentiated squamoas cell carcinoma of the lungと診断された．8月11日当科入院し，手術不能のため，レーザー照射施行し，肺腫瘍の縮小をみた．経過中，9月14日ごろより嚥下痛出現し，次第に増強，摂食困難となった．

　The patient was a 64 year-old woman and was admitted to our hospital complaining of persistent cough. Radiological and bronchoscopic examination led us to establish a diagnosis of moderately differentiated squamous cell carcinoma of the lung.

　During the admission, she started to have odynophagia. The endoscopic examination showed thick white degenerative epithelium covering entire esophageal lumen from the top to its end. A week later, second endoscopic examination revealed yellowbrownish necrotizing material covering whole esophageal lumen. The lesion easily bled and was scaled off. A diagnosis of exfoliative esophagitis was made from endoscopic and histological findings. Consequently, she was abstained from foods and oral medicine (ferrous sulfate and bacampicillin hydrochloride), and was given antacid. Subjective symptoms almost disappeared with no abnormalities endoscopically in two weeks.

We were unable to find any preceding physical damage of the esophagus in this case and furthermore, bacteriological, virological and histological studies did not suggest any etiology of this case. Reflux esophagitis was also denied. Although ingestion of foods and drugs may induce and exacerbate the disease, the real pathogenesis of exfoliative esophagitis in this case remains to be determined.