Eosinophils in the esophagus - Peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia
Eosinophils in the esophagus - Peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia
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DOI：
10.1111/j.1572-0241.2006.00562.x
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发表时间：
2006-07-01
影响因子：
9.8
通讯作者：
Fox, VL
中科院分区：
文献类型：
--
作者：
Ngo, P;Furuta, GT;Fox, VL
目的：食管远端散在的嗜酸性粒细胞传统上是消化性食管炎的标志，但食管中嗜酸性粒细胞的上限以及消化性炎症沿食管的纵向范围尚不清楚。最近，有上消化道症状且每高倍视野（eos/HPF）嗜酸性粒细胞>20个的成人和儿童被诊断为过敏性食管炎。过敏性食管炎缺乏标准化的诊断标准，且鳞状上皮中大量嗜酸性粒细胞的孤立发现已被用作其定义特征。我们诊治了3例有食管炎症状和内镜特征且食管黏膜每高倍视野嗜酸性粒细胞>20个的患者。经过2个月的质子泵抑制剂（PPI）治疗后，症状、内镜特征和组织学发现均得到缓解。本病例系列的目的是证明在消化性食管炎中也可观察到被认为与过敏性食管炎诊断相符的特征。
方法：对3例食管炎（每高倍视野嗜酸性粒细胞>20个）且症状和嗜酸性粒细胞增多经PPI治疗后缓解的患者进行回顾性病历审查。由一名病理学家以盲法对食管活检进行审查。
结果：患者（年龄分别为14岁、25岁和5岁）表现为吞咽困难、食物嵌塞和呕吐。内镜特征包括白色渗出物和线性沟纹。在内镜检查前，没有患者接受抗过敏治疗或饮食排除。仅用PPI治疗后，所有患者均无症状，内镜检查结果恢复正常。在所有3例患者中，PPI治疗前后每高倍视野嗜酸性粒细胞数量降至正常/接近正常（患者1从37个降至1个，患者2从21个降至3个，患者3从52个降至0个嗜酸性粒细胞/HPF）。
结论：在消化性食管炎中可看到大量嗜酸性粒细胞。这一组织学发现必须结合获取它的临床背景来解释。
OBJECTIVES: Scattered eosinophils in the distal esophagus traditionally provide the hallmark for peptic esophagitis, but the upper limit of eosinophils and the longitudinal extent of peptic inflammation along the esophagus are unknown. Recently, adults and children with upper intestinal symptoms and > 20 eosinophils/high-power field (eos/HPF) have been given the diagnosis of allergic esophagitis. Standardized diagnostic criteria for allergic esophagitis are lacking and the isolated finding of large numbers of eosinophils in the squamous epithelium has been used as the defining feature. We cared for three patients with symptoms and endoscopic features of esophagitis with > 20 eos/HPF in their esophageal mucosa. Symptoms, endoscopic features, and histologic findings resolved after 2 months of proton pump inhibitor (PPI) treatment. The aim of this case series is to demonstrate that features thought to be consistent with a diagnosis of allergic esophagitis are also observed in peptic esophagitis.METHODS: A retrospective chart review of three patients with esophagitis (> 20 eos/HPF) whose symptoms and eosinophilia resolved with PPI treatment was performed. Esophageal biopsies were reviewed in a blinded manner by one pathologist.RESULTS: Patients (aged 14, 25, and 5 yr) presented with dysphagia, food impaction, and vomiting. Endoscopic features included white exudates and linear furrows. None of the patients received antiallergic treatments or dietary eliminations prior to endoscopy. Following treatment with PPIs alone, all patients became asymptomatic and endoscopic findings reverted to normal. In all three patients, pre- and post-PPI treatment eosinophil numbers/HPF decreased to normal/near normal (37 to 1, 21 to 3, and 52 to 0 eosinophils/HPF in patients 1, 2, and 3, respectively).CONCLUSION: Large numbers of eosinophils can be seen in peptic esophagitis. This histologic finding must be interpreted in the context of the clinical setting in which it is obtained.