好酸球性消化管疾患の診断と治療―好酸球性食道炎

Eosinophilic Esophagitis

要旨　好酸球性食道炎（EoE）は，食道上皮に好酸球浸潤を認める慢性のアレルギー疾患である．当院で診断された17例のEoEを対象として，臨床像，内視鏡像，治療について検討した．平均年齢は49歳，男性が70.6％を占めた．主訴は胸やけが最も多く，次いで嚥下困難，つかえ感が続いた．内視鏡所見は縦走溝が最も多く，他に輪状溝，白斑を認めた．病理組織学的所見では，食道上皮に著明な好酸球浸潤（≧15/HPF）を認めた．治療は，PPIを第一選択とし，有効4例，無効6例であった．PPIが無効であった6例のうち，4例にステロイド治療を実施したところ，全例に有効であった．近年，本疾患の罹患率は増加している．日常診療において本疾患に遭遇する機会は増すと考えられ，今後，内視鏡医や病理医には，本疾患に対する認識を高めていくことが求められる．

　EoE（eosinophilic esophagitis）is a chronic allergic disease characterized by eosinophilic infiltration of the esophageal epithelium. Records of 17 patients diagnosed with EoE at our hospital between May, 2010 and April, 2013 were examined for age, sex, symptoms, endoscopic findings, and treatment. Patients were 70.6％ males with a mean age of 49 years. Symptoms included heartburn, dysphasia, and food impaction. Endoscopic findings of EoE include longitudinal furrows, mucosal edema, loss of vascular pattern, rings, and white exudates. Histopathological examination revealed eosinophilic infiltration（≧15 eosinophils/high-powered field）in the esophageal epithelium of all patients. PPI（proton pump inhibitor）therapy was administered as the first-line treatment but was ineffective in 6 patients out of 10. Steroid therapy was administered to 4 patients unresponsive to PPI therapy and was effective. EoE has received increased attention due to the recent increase in its prevalence. It is important that physicians engaging in endoscopy and pathologists should be aware of EoE.