食道内視鏡所見が診断の一助となった潰瘍性病変を伴う好酸球性胃腸炎の1例

Eosinophilic Gastroenteritis with Ulcerative Lesion Whose Esophageal Endoscopic Findings Were Helpful for Diagnosis, Report of a Case

要旨●患者は30歳代，女性．検診の上部消化管X線造影検査で異常を指摘され，精査目的に当院へ受診となった．上部消化管X線造影検査で胃体上部から胃角部大彎に微細な凹凸を伴う6cm大の病変を認めた．EGDで胃体上部から胃角部大彎にかけて周囲よりわずかに陥凹した黄色調病変を認めた．内部には境界不明瞭な発赤微細顆粒状粘膜と辺縁整な潰瘍を認めた．当初4型胃癌を疑ったが食道に縦走溝を認めたため，好酸球性消化管疾患の可能性を考え，臨床診断に追記し病理診断を依頼したところ好酸球性胃腸炎の診断となった．プレドニゾロンを開始し改善がみられた．食道病変が診断の一助となった，潰瘍性病変を伴う好酸球性胃腸炎の1例を経験したため，文献的考察を交えて報告する．

　We report a case of eosinophilic gastroenteritis with gastric ulcers and an esophageal lesion. Because of the esophageal lesion, we considered eosinophilic gastroenteritis.

　A female patient in her 30s was diagnosed with abnormalities on UGI（upper gastrointestinal series）and visited our hospital. UGI revealed a 6-cm lesion with fine irregularities from the gastric angle to the gastric body, and eosinophilia was also noted. Upper gastrointestinal endoscopy revealed a pale, slightly depressed lesion. The inside revealed cratered ulcers and an erythematous fine-granular mucosa with free margins. At first, we suspected type 4 gastric cancer ; however, we recognized the possibility of eosinophilic gastroenteritis disease due to the presence of esophageal linear furrows. Eosinophilic gastroenteritis was diagnosed by the histological findings of eosinophil infiltration on mucosal biopsy. Oral prednisolone was started at 30mg per day and tapered off, and endoscopic findings improved as a result. When atypical gastric lesions with eosinophilia are present, eosinophilic gastroenteritis should be one of the differential diagnoses.