Eosinophilic Esophageal Myositis (EoEM) Causes Jackhammer Esophagus, Rarely Posing a Problem in the Differential Diagnosis of Eosinophilic Esophagitis
Eosinophilic Esophageal Myositis (EoEM) Causes Jackhammer Esophagus, Rarely Posing a Problem in the Differential Diagnosis of Eosinophilic Esophagitis
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DOI：
10.1038/s41395-018-0171-z
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发表时间：
2018-06
期刊：
影响因子：
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通讯作者：
Hiroki Sato-;S. Terai
中科院分区：
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作者：
Hiroki Sato-;S. Terai
肌肉层中的嗜酸性粒细胞浸润引起严重的肌肉收缩。嗜酸性粒细胞性食管炎（EoE）的最早报告之一是贲门失弛缓症患者[2]，随后的报告描述了食管痉挛和肌肉层嗜酸性粒细胞浸润的患者[3]。2015年，我们首次报告了一例JE伴嗜酸性食管肌炎（EoEM）的病例[4]。在5例EoEM病例中（图1a），4例为JE，1例为胡桃夹食管（NE），与Tang等人的报告一致。此外，EoE是食管的主要嗜酸性粒细胞疾病。在此，我们讨论EoEM患者是否容易与EoE患者区分。如前所述[5]，我们的EoEM相关JE/NE病例未显示EoE的典型内镜表现，如食管环和白色渗出物。仅发现压缩壁（可能是水肿），导致内窥镜通道阻力增加。对于每例患者，我们在经口内镜肌切开术（POEM）前进行了6次食管粘膜活检，未观察到EoE的特征性组织学发现（嗜酸性粒细胞浸润≥ 15/高倍视野（HPF），细胞间隙扩张或微水肿）。在后3例中，在POEM期间，通过帽式内窥镜创建粘膜进入部位
eosinophilic infiltration in the muscle layer causes severe muscular contractions. One of the earliest reports of eosinophilic esophagitis (EoE) was in a patient with achalasia [2], and a subsequent report described a patient with esophageal spasm and eosinophilic infiltration in the muscle layer [3]. In 2015, we first reported a case of JE with eosinophilic esophageal myositis (EoEM)[4]. Among the 5 cases of EoEM (Fig. 1a), 4 were JEs and 1 was a nutcracker esophagus (NE), compatible to that reported by Tang et al. Further, EoE is a major eosinophilic disorder of the esophagus. Herein, we discuss whether patients with EoEM are easily distinguished from those with EoE.As described previously [5], our cases with EoEM-related JE/NE did not show typical endoscopic findings of EoE such as esophageal rings and white exudates. Only a compressed wall (which may be as edematous) was identified, leading to increased resistance of endoscope passage. For each patient, we performed 6 esophageal mucosal biopsies before peroral endoscopic myotomy (POEM), and no characteristic histological findings of EoE (eosinophilic infiltration≥ 15/high power field (HPF), dilated intercellular spaces, or micro-abscesses) were observed. In the latter 3 cases, during POEM, a mucosal entry site was created by cap-fitted endoscopic