難治性多発性深掘れ潰瘍を呈した好酸球性胃腸炎の1例

Eosinophilic Gastroenteritis, Report of a Case

要旨　患者は27歳，男性．主訴は心窩部痛，嘔吐，体重減少．他院でH2ブロッカーの内服治療を数か月受けたが，症状が改善しないため，当院を受診した．上部消化管内視鏡検査では胃および十二指腸に多発性深掘れ潰瘍を認めた．プロトンポンプ阻害薬（PPI）を約2年間投与したが，潰瘍病変は寛解と再燃を繰り返した．好酸球性胃腸炎を疑い，アレルギー検査を行ったところ，卵白，牛肉，豚肉に陽性を示し，胃生検の病理組織学的所見では，粘膜固有層に20個/HPF以上の好酸球浸潤を認めたため，好酸球性胃腸炎と診断した．プレドニゾロン（PSL）の内服加療を開始したところ，潰瘍は速やかに瘢痕化した．その後PSLを漸減中止したところ，約1か月で再燃した．現在，少量のPSLとPPIの継続投与を行っている．

　A 27-year-old man with complaints of epigastralgia, vomiting, and body weight loss, had been treated with H2 blocker in another clinic for a few months. He came to our clinic because of no improvement in his complaints. Esophagogastroduodenoscopy revealed multiple gastroduodenal ulcers. Although proton pump inhibitor had been given for more than two years, the ulcerous legions relapsed repeatedly. Such intractable ulcers led us to take eosinophilic gastroenteritis into consideration. The test for food allergy revealed positive reaction to albumen, beef, and pork. The diagnosis of eosinophilic gastroenteritis was made with the pathological finding of intensive infiltration（more than 20 cells per high power field）of eosinophilic leukocytes into the lamina propria of the mucous membrane in biopsy specimens of gastric lesions. The ulcerous legions healed to the scarring stage after a short term by oral intake of PSL（prednisolone）. However, discontinuance of PSL resulted in the recurrence of ulcers within one month. Up to now, low-dose administration of PSL and PPI maintenance therapy has been used.