胃と腸48巻13号

2013年12月発行

今月の主題 好酸球性消化管疾患の概念と取り扱い 主題

好酸球性消化管疾患の診断と治療―好酸球性食道炎

著者： 友松雄一郎¹ 芳野純治¹ 乾和郎¹ 若林貴夫¹ 片野義明¹ 小林隆¹ 三好広尚¹ 小坂俊仁¹ 山本智支¹ 松浦弘尚¹ 成田賢生¹ 鳥井淑敬¹ 森智子¹ 安江祐二¹ 黒川雄太¹ 細川千佳生¹

所属機関： ¹藤田保健衛生大学坂文種報徳會病院内科

ページ範囲：P.1873 - P.1881

要旨　好酸球性食道炎（EoE）は，食道上皮に好酸球浸潤を認める慢性のアレルギー疾患である．当院で診断された17例のEoEを対象として，臨床像，内視鏡像，治療について検討した．平均年齢は49歳，男性が70.6％を占めた．主訴は胸やけが最も多く，次いで嚥下困難，つかえ感が続いた．内視鏡所見は縦走溝が最も多く，他に輪状溝，白斑を認めた．病理組織学的所見では，食道上皮に著明な好酸球浸潤（≧15/HPF）を認めた．治療は，PPIを第一選択とし，有効4例，無効6例であった．PPIが無効であった6例のうち，4例にステロイド治療を実施したところ，全例に有効であった．近年，本疾患の罹患率は増加している．日常診療において本疾患に遭遇する機会は増すと考えられ，今後，内視鏡医や病理医には，本疾患に対する認識を高めていくことが求められる．

参考文献

1）Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology 74 : 1298-1301, 1978

2）Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults : a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 133 : 1342-1363, 2007

3）Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis : updated consensus recommendations for children and adults. J Allergy Clin Immunol 128 : 3-20 e26, 2011

4）Furuta K, Adachi K, Kowari K, et al. A Japanese case of eosinophilic esophagitis. J Gastroenterol 41 : 706-710, 2006

5）木下芳一，三代剛，玉川祐司，他．食道炎の内視鏡診断─好酸球性食道炎．胃と腸 46 : 1225-1232, 2011

6）Blanchard C, Wang N, Stringer KF, et al. Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis. J Clin Invest 116 : 536-547, 2006

7）Rothenberg ME. Biology and treatment of eosinophilic esophagitis. Gastroenterology 137 : 1238-1249, 2009

8）木下芳一，石原俊治，天野祐二，他．好酸球性食道炎の診断と治療．Gastroenterol Endosc 53 : 3-15, 2011

9）石村典久，木下芳一．好酸球性食道・胃腸炎．消臨 16 : 5-14, 2013

10）Straumann A, Simon HU. Eosinophilic esophagitis : escalating epidemiology ? J Allergy Clin Immunol 115 : 418-419, 2005

11）Prasad GA, Alexander JA, Schleck CD, et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol 7 : 1055-1061, 2009

12）Fujishiro H, Amano Y, Kushiyama Y, et al. Eosinophilic esophagitis investigated by upper gastrointestinal endoscopy in Japanese patients. J Gastroenterol 46 : 1142-1144, 2011

13）Pasha SF, DiBaise JK, Kim HJ, et al. Patient characteristics, clinical, endoscopic, and histologic findings in adult eosinophilic esophagitis : a case series and systematic review of the medical literature. Dis Esophagus 20 : 311-319, 2007

14）Müller S, Pühl S, Vieth M, et al. Analysis of symptoms and endoscopic findings in 117 patients with histological diagnoses of eosinophilic esophagitis. Endoscopy 39 : 339-344, 2007

15）Tomomatsu Y, Yoshino J, Inui K, et al. Clinical features of eosinophilic esophagitis : ten Japanese cases. Dig Endosc 25 : 117-124, 2013

16）Remedios M, Campbell C, Jones DM, et al. Eosinophilic esophagitis in adults : clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate. Gastrointest Endosc 63 : 3-12, 2006

17）Odze RD. Pathology of eosinophilic esophagitis : what the clinician needs to know. Am J Gastroenterol 104 : 485-490, 2009

18）Gonsalves N, Policarpio-Nicolas M, Zhang Q, et al. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc 64 : 313-319, 2006

19）Fox VL, Nurko S, Teitelbaum JE, et al. High-resolution EUS in children with eosinophilic“allergic”esophagitis. Gastrointest Endosc 57 : 30-36, 2003

20）Bohm M, Richter JE. Treatment of eosinophilic esophagitis : overview, current limitations, and future direction. Am J Gastroenterol 103 : 2635-2644, 2008

21）Attwood SE, Lewis CJ, Bronder CS, et al. Eosinophilic oesophagitis : a novel treatment using Montelukast. Gut 52 : 181-185, 2003

22）Straumann A, Conus S, Grzonka P, et al. Anti-interleukin-5 antibody treatment（mepolizumab）in active eosinophilic oesophagitis : a randomized, placebo-controlled, double-blind trial. Gut 59 : 21-30, 2010

23）Blanchard C, Stucke EM, Burwinkel K, et al. Coordinate interaction between IL-13 and epithelial differentiation cluster genes in eosinophilic esophagitis. J Immunol 184 : 4033-4041, 2010