Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies: A review of the literature
Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies: A review of the literature
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DOI：
10.3748/wjg.14.1463
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发表时间：
2008-03-07
影响因子：
4.3
通讯作者：
Prieto-Bermejo, Ana Beatriz
中科院分区：
文献类型：
--
作者：
Molina-Infante, Javier;Ferrando-Lamana, Lucia;Prieto-Bermejo, Ana Beatriz
嗜酸性食管炎（EE）和胃食管反流病（GERD）具有重叠的临床、测压、内镜和组织病理学特征。目前，EE的诊断是基于食管活检中每个高倍视野（eo/HPF）中存在15个或更多嗜酸性粒细胞。我们报告了两名年轻男性患有吞咽困难和复发性食物嵌塞伴反流性食管炎的病例，中上段食管活检超过20 eo/HPF，这两种情况在质子泵抑制剂（PPI）治疗后均无症状。如24小时食管pH监测所示，第一名患者也实现了组织学缓解，而另一名患者在有效PPI治疗后仍存在EE。局部类固醇治疗联合PPI导致后者患者完全缓解。GERD和EE可能无法区分，即使是通过组织学，因此EE的诊断只能在严格抑酸下获得的临床，内窥镜和病理学数据的仔细相关后才能确定。当疾病重叠时，这些诊断困难最大。关于这一主题的数据有限，EE和GERD之间的相互作用是一个有争议的问题。在这种情况下，对接受PPI治疗的患者进行中上段食管分步活检和食管pH监测对于评价每种疾病的作用至关重要。在组织病理学诊断为EE的患者中，PPI试验是强制性的;在PPI治疗无效的患者中，应建议EE。然而，如本报告所示，PPI的临床应答可能不排除静止期EE。(c)2008年WJG。All rights reserved.
Eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD) have overlapping clinical, manometric, endoscopic and histopathologic features. The diagnosis of EE is nowadays based upon the presence of 15 or more eosinophils per high power field (eo/HPF) in esophageal biopsies. We report the cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies, both of which became asymptornatic on proton pump inhibitor (PPI) therapy. The first patient also achieved a histologic response, while EE remained in the other patient after effective PPI treatment, as shown by 24-h esophageal pH monitoring. Topical steroid therapy combined with PPI led to complete remission in this latter patient. GERD and EE may be undistinguishable, even by histology, so diagnosis of EE should only be established after a careful correlation of clinical, endoscopic and pathologic data obtained under vigorous acid suppression. These diagnostic difficulties are maximal when bott),diseases overlap. Limited data are available about this topic, and the interaction between EE and GERD is a matter of debate. In this setting, upper-mid esophagus step biopsies and esophageal pH monitoring of patients on PPI therapy are pivotal to evaluate the role of each disease. A PPI trial is mandatory in patients with a histopathologic diagnosis of EE; in those unresponsive to PPI treatment, EE should be suggested. However, a clinical response to PPI may not rule out quiescent EE, as shown in this report. (c) 2008 WJG. All rights reserved.