Crohn病を合併した好酸球性食道炎の1例

Eosinophilic Esophagitis Complicated with Crohn's Disease, Report of a Case

要旨●患者は20歳代，男性．18歳時に小腸型Crohn病と診断されたが，治療を自己中断していた．200X年にCrohn病再燃で入院した際の上部消化管内視鏡検査（EGD）で中部食道中心に白斑付着と発赤調の縦走溝所見を，生検で扁平上皮層内に高倍率視野1視野内に約30個の好酸球浸潤を認めた．無症状のため，好酸球性食道炎疑診例とし，メサラジンと成分栄養食でCrohn病治療を開始し寛解導入できた．約4か月後に食物つかえ感，胸やけ症状が出現し，再検したEGD所見ならびに生検所見とあわせて，好酸球性食道炎と確定診断した．フルチカゾンプロピオン酸エステルの嚥下療法を開始したところ，症状は改善し，好酸球浸潤も消失した．

　A 29-year-old man, diagnosed with CD（Crohn's disease）at the age of 18 years, was referred to our department because of the relapse of CD. Upper gastrointestinal endoscopy revealed esophageal white stipple-like exudates and red linear furrows, and the pathological examination of biopsy specimens revealed eosinophil infiltration, with approximately 30 eosinophils per high-power field. EoE（eosinophilic esophagitis）was suspected ; however, the treatment of only CD was initiated because the patient was asymptomatic for EoE, with no dysphagia, food impaction, or heartburn. After the remission of CD, food impaction and heartburn developed without any changes in the endoscopic and pathological findings and the diagnosis of EoE was confirmed. The patient received swallowed fluticasone therapy for 8 weeks. The patient's symptoms immediately improved, and the endoscopic and histological findings improved as well.