高度食道狭窄を来した難治性逆流性食道炎の1例

Reflux Esophagitis with Severe Esophageal Stenosis, Report of a Case

要旨　患者は48歳，男性．主訴は通過障害．上部消化管造影所見では，下部食道のlcm長の狭窄と十二指腸球部の変形を認めた．内視鏡検査では，ピンホール状の食道狭窄とその口側に潰瘍形成を認めた．潰瘍部以外にヨード不染帯はなく，潰瘍部，狭窄部ともに生検では悪性所見は得られなかった．FDG-PETの結果も加え，逆流性食道炎に基づく良性食道狭窄と診断し，内視鏡的食道拡張術と内服薬による治療を行った．3回の食道拡張術にて，経口摂取可能となり，退院となった．その後，再狭窄と食道炎の増悪を交互に繰り返していたが，現在は酸分泌抑制剤などの投薬にて症状のコントロールが良好であり，外来にて経過観察中である．本例をもとに，食道癌との鑑別診断および良性食道狭窄の治療について考察を行った．

　We report here the case of a 48-year-old man who complained of difficulty in swallowing. Upper gastrointestinal radiograph showed a 1 cm-long stenosis in the lower esophagus and an abnormally shaped duodenal cap. Upper gastrointestinal endoscopy revealed a pinhole shaped stenosis of the esophagus and an ulcer forming in the upper part of the stenosis. Absence of iodine staining was noted only in the ulcer part. No malignacy was observed in biopsy specimens. Benign stenosis of the esophagus associated with peptic esophagitis was diagnosed by FDG-PET and treated by endoscopic dilation and drug therapy. After three endoscopic dilation the patient could ingest and was discharged. Restenosis and aggravation of esophagitis recurred alternately, but at present, the symptoms are managed with antacid and the patient is routinely observed at our clinic. Using this case, we discuss the diagnosis and treatment of benign stenosis of the esophagus and the importance of differentiating it from esophageal cancer.