好酸球性食道炎の治療

Treatment for Eosinophilic Esophagitis

要旨●好酸球性食道炎は食物のつまり感や嚥下困難などの食道症状があり，上皮内好酸球が高視野で15個以上浸潤している慢性アレルギー疾患である．約半数以上がプロトンポンプ阻害薬に反応し〔いわゆるPPI反応性食道好酸球浸潤（PPI-REE）〕，残りのほとんどの症例はステロイド嚥下療法が有効である．しかしながら，薬剤の用量，投与期間など治療法として確立されていない部分も多い．そのほか，欧米の報告では4〜6種類の除去食，狭窄例に対する内視鏡的拡張術，生物学的製剤の有効性が挙げられている．

　EoE（Eosinophilic esophagitis）is a chronic immune-mediated disease characterized by esophageal symptoms, such as dysphagia and food impaction, as well as an intraepithelial eosinophil infiltration of ≧15 per high power field. More than half of the cases with EoE clinically and histologically respond to PPI（proton pump inhibitor）therapy, which is known as PPI-responsive esophageal eosinophilia. The remaining cases can be treated by topical steroid therapy. However, the doses and duration of PPIs or steroids have not been established yet. Several studies from western counties report the efficacy of endoscopic balloon dilation, six or four food elimination diet therapy, and biologics for treating EoE.