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トピックス―GERDと好酸球性食道炎

著者： 阿部靖彦¹ 野村栄樹¹ 佐藤剛司¹ 佐々木悠¹ 吉澤和哉¹ 岩野大輔¹ 八木周¹ 作田和裕¹ 渋谷りか¹ 西瀬祥一¹ 猪股芳文² 加藤勝章³ 飯島克則⁴ 上野義之¹

所属機関： ¹山形大学医学部内科学第二（消化器内科学）講座 ²JR仙台病院消化器科 ³宮城県対がん協会がん検診センター ⁴東北大学病院消化器内科

ページ範囲：P.1911 - P.1920

要旨　好酸球性食道炎（eosinophilic esophagitis ; EoE）の診断には，他に好酸球浸潤を来しうる疾患を除外することが必要で，実臨床ではGERDとの鑑別が重要となる．EoEの典型的な症状は食物のつかえ感であるが，胸やけなど逆流症状を主訴とする場合も多いため，症状のみから両者を鑑別することは困難である．GERDでも軽度の好酸球浸潤を来しうることを考慮し，臨床症状に加えて，生検で好酸球が15個/HPF以上であること，PPIが無効であること，異常酸逆流がないことを満たす場合にEoEと診断する基準が用いられてきた．内視鏡的に縦走溝，輪状溝，白色滲出物などの特徴的な所見を示す典型例ではGERDとの鑑別は比較的容易であるが，所見が乏しい場合もあるため，生検を行って好酸球浸潤の有無を確認することが重要である．米国における最新の診断ガイドラインによれば，臨床および組織所見からEoEが疑われた場合にはPPI投与を行い，PPIに反応しない例をEoEと診断し，PPIで所見が消失してしまう例はPPI-responsive esophageal eosinophiliaとしてEoEとは区別するように提唱されている．

参考文献

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