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摘要:
本文报道一例因吞咽困难而就诊的嗜酸性粒细胞性食管炎病例。该患者为54岁女性，超声胃镜可见食管弥漫性增厚，病理示食管鳞状上皮内散在嗜酸性粒细胞浸润伴嗜酸性粒细胞微脓肿形成，嗜酸性粒细胞计数密度约为30个/HPF，符合嗜酸性粒细胞性食管炎的诊断标准(中度活动性)。口服醋酸泼尼松30 mg/d并逐步减量后，患者临床症状明显减轻，且影像学证实病变具有明显改善。本文总结该患者的诊疗经过并结合文献进行深入剖析，以期提升临床医生对该病的认知。
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关键词:
- 嗜酸性粒细胞性食管炎 /
- 高分辨率食管压力测量 /
- 超声胃镜
Abstract:This paper reports a case of eosinophilic esophagitis who presented with dysphagia. The patient was a 54-year-old woman with diffuse esophageal thickening on ultrasonographic gastroscopy. Pathology demonstrated scattered eosinophilic infiltration within the squamous epithelium of the esophagus, accompanied by eosinophilic microabscess, and the counting density of eosinophilic cells was about 30/HPF, which was consistent with the diagnostic criteria of eosinophilic esophagitis (moderately active). After oral administration of prednisone acetate 30 mg/d and gradual reduction of the dose, the patient's clinical symptoms were significantly eased, and the imaging confirmed the improvement of the lesions. This article summarizes the patient's diagnostic and therapeutic process, and reviews the relevant literature in order to enhance clinicians' understanding of this disease.
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图 1 患者治疗前辅助检查
A. 白光胃镜检查(2019年9月12日)，示食管痉挛、黏膜充血和水肿；B. 超声胃镜(2019年9月12日)示食管中下部弥漫性增厚，肌层厚度约为5.6 mm；C. 病理(2019年9月18日)示食管鳞状上皮内散在嗜酸性粒细胞浸润(红色箭头)伴嗜酸性粒细胞微脓肿形成，密集处嗜酸性粒细胞计数约为30个/HPF(HE，×400)
Figure 1. Ancillary examinations of the patient before treatment
A. white light gastroscopy (September 12, 2019) showed esophageal spasm, mucosal congestion, and edema; B. ultrasonographic gastroscopy (September 12, 2019) showed diffuse thickening of the lower and middle esophagus, with a myxoid thickness of approximately 5.6 mm; C. pathology (September 18, 2019) showed scattered eosinophilic infiltration within the squamous epithelium of the esophagus (red arrows) accompanied by eosinophilic microabscesses formation, with an eosinophil count of approximately 30 eosinophils/HPF in the dense areas (HE, ×400)
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图 2 患者治疗后辅助检查
A. 白光胃镜(2019年12月24日)检查可见正常的食管黏膜和食管蠕动；B. 超声胃镜(2019年12月24日)示弥漫性食管增厚较前减轻，肌层厚度约为3.1 mm；C. 病理(2019年12月26日)示食管组织内仅见极个别嗜酸性粒细胞(HE，×400)
Figure 2. Ancillary examinations of the patient after treatment
A. white light gastroscopy (December 24, 2019) showed normal esophageal mucosa and esophageal peristalsis; B. ultrasound gastroscopy (December 24, 2019) showed that diffuse esophageal thickening was reduced compared with the previous one, and the thickness of the muscularis propria was about 3.1 mm; C. pathology (December 26, 2019) showed that only a very small number of eosinophilic granulocytes were seen in the esophageal tissues (HE, ×400)
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[1] Muir A, Falk G W. Eosinophilic esophagitis: a review[J]. JAMA, 2021, 326(13): 1310-1318. DOI: 10.1001/jama.2021.14920
[2] Landres R T, Kuster G G, Strum W B. Eosinophilic esophagitis in a patient with vigorous achalasia[J]. Gastroenterology, 1978, 74(6): 1298-1301. DOI: 10.1016/0016-5085(78)90710-2
[3] Navarro P, Arias Á, Arias-González L, et al. Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies[J]. Aliment Pharmacol Ther, 2019, 49(9): 1116-1125. DOI: 10.1111/apt.15231
[4] Dellon E S, Hirano I. Epidemiology and natural history of eosinophilic esophagitis[J]. Gastroenterology, 2018, 154(2): 319-332. e3. DOI: 10.1053/j.gastro.2017.06.067
[5] Schoepfer A M, Safroneeva E, Bussmann C, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner[J]. Gastroenterology, 2013, 145(6): 1230-1236. e2. DOI: 10.1053/j.gastro.2013.08.015
[6] Warners M J, Oude Nijhuis R A B, De Wijkerslooth L R H, et al. The natural course of eosinophilic esophagitis and long-term consequences of undiagnosed disease in a large cohort[J]. Am J Gastroenterol, 2018, 113(6): 836-844. DOI: 10.1038/s41395-018-0052-5
[7] Taft T H, Carlson D A, Simons M, et al. Esophageal hypervigilance and symptom-specific anxiety in patients with eosinophilic esophagitis[J]. Gastroenterology, 2021, 161(4): 1133-1144. DOI: 10.1053/j.gastro.2021.06.023
[8] Naik R D, Patel D A. Unlocking the mind might be critical in management of eosinophilic esophagitis: expanding beyond drugs, dilation, and Diet[J]. Gastroenterology, 2021, 161(4): 1099-1101. DOI: 10.1053/j.gastro.2021.07.032
[9] Hirano I, Moy N, Heckman M G, et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system[J]. Gut, 2013, 62(4): 489-495. DOI: 10.1136/gutjnl-2011-301817
[10] Gonsalves N P, Aceves S S. Diagnosis and treatment of eosinophilic esophagitis[J]. J Allergy Clin Immunol, 2020, 145(1): 1-7. DOI: 10.1016/j.jaci.2019.11.011
[11] Dellon E S, Khoury P, Muir A B, et al. A clinical severity index for eosinophilic esophagitis: development, consensus, and future directions[J]. Gastroenterology, 2022, 163(1): 59-76. DOI: 10.1053/j.gastro.2022.03.025
[12] Dellon E S, Liacouras C A, Molina-Infante J, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference[J]. Gastroenterology, 2018, 155(4): 1022-1033. e10. DOI: 10.1053/j.gastro.2018.07.009
[13] Steiner S J, Gupta S K, Croffie J M, et al. Correlation between number of eosinophils and reflux index on same day esophageal biopsy and 24 hour esophageal pH monitoring[J]. Am J Gastroenterol, 2004, 99(5): 801-805. DOI: 10.1111/j.1572-0241.2004.04170.x
[14] Parfitt J R, Gregor J C, Suskin N G, et al. Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients[J]. Mod Pathol, 2006, 19(1): 90-96. DOI: 10.1038/modpathol.3800498
[15] Lee S, De Boer W B, Naran A, et al. More than just counting eosinophils: proximal oesophageal involvement and subepithelial sclerosis are major diagnostic criteria for eosinophilic oesophagitis[J]. J Clin Pathol, 2010, 63(7): 644-647. DOI: 10.1136/jcp.2010.078402
[16] Biedermann L, Straumann A. Mechanisms and clinical management of eosinophilic oesophagitis: an overview[J]. Nat Rev Gastroenterol Hepatol, 2023, 20(2): 101-119. DOI: 10.1038/s41575-022-00691-x
[17] Schaefer E T, Fitzgerald J F, Molleston J P, et al. Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis: a randomized trial in children[J]. Clin Gastroenterol Hepatol, 2008, 6(2): 165-173. DOI: 10.1016/j.cgh.2007.11.008
[18] Tan N D, Xiao Y L, Chen M H. Steroids therapy for eosinophilic esophagitis: systematic review and meta-analysis[J]. J Dig Dis, 2015, 16(8): 431-442. DOI: 10.1111/1751-2980.12265
[19] Lucendo A J, Molina-Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults[J]. United European Gastroenterol J, 2017, 5(3): 335-358. DOI: 10.1177/2050640616689525
[20] Dellon E S, Woosley J T, Arrington A, et al. Efficacy of budesonide vs fluticasone for initial treatment of eosinophilic esophagitis in a randomized controlled trial[J]. Gastroenterology, 2019, 157(1): 65-73. e5. DOI: 10.1053/j.gastro.2019.03.014
[21] Dellon E S, Rothenberg M E, Collins M H, et al. Dupilumab in adults and adolescents with eosinophilic esophagitis[J]. N Engl J Med, 2022, 387(25): 2317-2330. DOI: 10.1056/NEJMoa2205982
[22] Straumann A. Biologics in eosinophilic esophagitis-ready for prime time? [J]. N Engl J Med, 2022, 387(25): 2379-2380. DOI: 10.1056/NEJMe2213030
[23] Hirano I, Dellon E S, Hamilton J D, et al. Efficacy of dupilumab in a phase 2 randomized trial of adults with active eosinophilic esophagitis[J]. Gastroenterology, 2020, 158(1): 111-122. e10. DOI: 10.1053/j.gastro.2019.09.042
[24] Ridolo E, Barone A, Ottoni M, et al. The new therapeutic frontiers in the treatment of eosinophilic esophagitis: biological drugs[J]. Int J Mol Sci, 2024, 25(3): 1702. DOI: 10.3390/ijms25031702
[25] Von Arnim U, Biedermann L, Aceves S S, et al. Monitoring patients with eosinophilic esophagitis in routine clinical practice-international expert recommendations[J]. Clin Gastroenterol Hepatol, 2023, 21(10): 2526-2533. DOI: 10.1016/j.cgh.2022.12.018
[26] De Bortoli N, Visaggi P, Penagini R, et al. The 1st EoETALY consensus on the diagnosis and management of eosinophilic esophagitis-definition, clinical presentation and diagnosis[J]. Dig Liver Dis, 2024, 56(6): 951-963. DOI: 10.1016/j.dld.2024.02.005
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