eosinophilic esophagitis

好酸球性食道炎

WordNet

1. of or relating to eosinophil
2. inflammation of the esophagus; often caused by gastroesophageal reflux (同)oesophagitis
3. a leukocyte readily stained with eosin (同)eosinophile

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/08/31 19:27:56」(JST)

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Eosinophilic esophagitis
Classification and external resources
Micrograph showing eosinophilic esophagitis. H&E stain.
ICD-10	K20
ICD-9	530.13

Endoscopic image of esophagus in a case of eosinophilic esophagitis. Concentric rings are termed trachealization of the esophagus.

The barium swallow of the esophagus on the left side shows multiple rings associated with eosinophilic esophagitis.

Eosinophilic esophagitis (eosinophilic oesophagitis) is an allergic inflammatory condition of the esophagus, and also called allergic oesophagitis. Symptoms are swallowing difficulty, food impaction, and heartburn.

Eosinophilic oesophagitis (EE) was first described in children but occurs in adults as well. The condition is not well understood, but food allergy may play a significant role.

Symptoms

EE is associated with oesophageal strictures, and often presents with food impaction, dysphagia, and heartburn. In addition, young children with eosinophilic esophagits may present with feeding difficulties. It is more common in males, and affects both adults and children.

Pathophysiology

EE is considered a relatively poorly-understood disease of which awareness is arising.

EE is characterised by a dense eosinophilic infltrate into the epithelium of the squamous oesophagus. This is thought to be probably an allergic reaction against ingested food, based on the important role eosinophils play in allergic reactions. Eosinophils are inflammatory cells that release a variety of cytokines which inflame the surrounding oesophageal tissue. This results in symptoms of pain, visible redness on endoscopy, and a natural history that may include stricturisation.

A characteristic set of genes termed the "EE transcriptome" is expressed and distinguishes patients with EE from unaffected individuals or from patients with other forms of esophagitis.

Genetic & Autoimmune Links

Many EE patients suffer from concurrent autoimmune and allergic disease. This includes asthma and coeliac disease.

Diagnosis

The diagnosis of EE is typically made clinicopathologically.

Clinical Findings. Clinically, EE can be only be diagnosed if gastroesophageal reflux is not responsive to a 6 week trial of twice-a-day high-dose proton-pump inhibitors (PPIs) or if a negative ambulatory pH study rules out gastroesophageal reflux disease (GERD).

Histology. On esophagogastroduodenoscopic biopsy, numerous eosinophils can be seen in the superficial epithelium. A minimum of 15 eosinophils per high-power field are required to make the diagnosis. Eosinophilic inflammation is limited to the oesophagus alone, and does not extend into the stomach or duodenum. Profoundly degranulated eosinophils may also be present, as may microabcesses and an expansion of the basal layer.

Endoscopy. Endoscopically, ridges, furrows, or rings may be seen in the oesophageal wall. Sometimes, multiple rings may occur in the esophagus, leading to the term "corrugated esophagus" or "feline esophagus" due to similarity of the rings to the cat esophagus. Presence of white exudates in esophagus is also suggestive of the diagnosis.

Radiology. Radiologically, the term "ringed esophagus" has been used for the appearance of eosinophilic esophagitis on barium esophagrams to contrast with the appearance of transient transverse folds sometimes seen with esophageal reflux (termed "feline esophagus").

Treatment

Treatment strategies include dietary modification to exclude food allergens, medical therapy, and mechanical dilatation of the esophagus.

The initial approach to the disorder is often allergy evaluation in an attempt to identify the allergens in the diet or environment that may be triggering the condition. If the offending agent is found, the diet is modified so that these allergens are eliminated. There are cases, especially in children, where there are multiple food allergies involved. Some patients require an elemental diet through the use of a specialty formula. Sticking to this diet and drinking the required amount of formula can be difficult. The use of feeding tubes in these situations is often required.^{[citation needed]}

First-line therapy is with swallowed liquid corticosteroids and other anti-inflammatories, including fluticasone, a topical viscous budesonide oral suspension.^{[citation needed]}. Patients with severe symptoms despite these interventions may require oral corticosteroids such as methylprednisolone.^{[citation needed]} Other anti-inflammatory agents have also been trialled, including leukotriene antagonists such as montelukast, anti-interleukins such as the anti-IL-5 monoclonal antibody mepolizumab, and antihistamines such as loratadine. Unfortunately, these have shown little clinical benefit.^{[citation needed]}

Mechanical dilatation may be considered in severe cases of EE that have progressed to esophageal stricture or severe stenosis. Dilatation is accomplished by passing dilators through the mouth and down the esophagus to gently expand its diameter. As the esophagus of patients with EE is rather thin and delicate, care is taken not to perforate the esophagus by overzealous dilatation.^{[citation needed]}

PPI use. Despite EE being historically thought of as refractory to PPI treatment, there is some recent evident to suggest a significant proportion of patients suffering from EE achieving remission following PPI therapy.

See also

• Eosinophilic gastroenteritis
• Allergy
• Gastroenteritis

References

External links

• CURED Foundation - Non-Profit for EGID Research
• American Partnership for Eosinophilic Disorders
• Families Affected By Eosinophilic Disorders
• Canadian Council of Eosinophilic Disorders
• Cincinnati Center for Eosinophilic Disorders
• Australian Support for Eosinophilic Disorders

UpToDate Contents

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• 1. 好酸球性食道炎の臨床症状および診断 clinical manifestations and diagnosis of eosinophilic esophagitis
• 2. 好酸球性食道炎の治療 treatment of eosinophilic esophagitis
• 3. 好酸球性食道炎の食事療法 dietary management of eosinophilic esophagitis
• 4. 好酸球性食道炎（EoE）：遺伝学および免疫病原性 eosinophilic esophagitis eoe genetics and immunopathogenesis
• 5. 好酸球性食道炎におけるアレルギー検査 allergy testing in eosinophilic esophagitis

English Journal

• Levels of circulating TNF-related apoptosis-inducing ligand in celiac disease.

• Celeghini C1, Not T2, Norcio A3, Monasta L3, Secchiero P4.
• Experimental and therapeutic medicine.Exp Ther Med.2014 Dec;8(6):1906-1908. Epub 2014 Oct 15.
• It has previously been demonstrated that the circulating levels of TNF-related apoptosis-inducing ligand (TRAIL) are significantly lower in patients with type 1 diabetes (T1D) than in normal age- and gender-matched controls. Since celiac disease (CD) is often associated with T1D, a retrospective stu
• PMID 25371753

• Topical Corticosteroids Do Not Revert the Activated Phenotype of Eosinophils in Eosinophilic Esophagitis but Decrease Surface Levels of CD18 Resulting in Diminished Adherence to ICAM-1, ICAM-2, and Endothelial Cells.

• Lingblom C1, Bergquist H, Johnsson M, Sundström P, Quiding-Järbrink M, Bove M, Wennerås C.
• Inflammation.Inflammation.2014 Dec;37(6):1932-44. doi: 10.1007/s10753-014-9926-x.
• Swallowed topical corticosteroids are the standard therapy for eosinophilic esophagitis (EoE) in adults. Eosinophils in the blood of untreated EoE patients have an activated phenotype. Our aim was to determine if corticosteroids restore the phenotype of eosinophils to a healthy phenotype and if cert
• PMID 24870064

Japanese Journal

• 症例報告 鶏卵アレルギーに対する急速経口免疫療法によって発症したと考えられた好酸球性食道-胃腸炎の1例

• 岡本 義久,栗原 和幸
• アレルギー 64(1), 57-62, 2015-02
• NAID 40020350876

• クローン病に合併した好酸球性食道炎の1例

• 宮岡 洋一,塚野 航介,上野 さや香,山之内 智志,楠 龍策,伊藤 聡子,藤代 浩史,高下 成明,大沼 秀行,木下 芳一
• 日本消化器内視鏡学会雑誌 57(2), 128-133, 2015
• 症例は29歳男性．2001年に小腸型クローン病と診断されたが，治療自己中断．2012年にクローン病再燃で入院した際の上部消化管内視鏡で中部食道中心に白斑の付着と発赤した縦走溝所見を，生検で扁平上皮層内に高倍率視野1視野内に20個以上の好酸球浸潤を認めた．無症状のため，好酸球性食道炎疑診例とし，メサラジンと成分栄養食でクローン病治療を開始し寛解導入できた．約4カ月後に胸部つかえ感，胸やけ症状が出現し …
• NAID 130004811859

Related Links

• Eosinophilic Esophagitis (EoE) Information - Children and EE ...

Patient and Family guide to Eosinphilic Esophagitis. Information on symptoms, diagnosis, allergy testing, steroid treatment, diet therapy, and prognosis. Eosinophilic Esophagitis (EE or EoE) is an emerging disease that is ...

• Eosinophilic Esophagitis (EoE) - The American Academy of ...

An overview of eosinophilic esophagitis (EoE) symptoms, diagnosis, treatment and management written and reviewed by the leading experts in allergy, asthma and immunology. ... Eosinophilic Esophagitis (EoE) Eosinophilic (ee-uh ...

Related Pictures

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★リンクテーブル★

リンク元	「好酸球性食道炎」
関連記事	「eosinophilic」

「好酸球性食道炎」

　　[★]

英

eosinophilic esophagitis EoE

関

食道炎、好酸球性消化管疾患

概念

• 食道の食道粘膜上皮層に多数の好酸球が慢性的に浸潤したもの。その結果、粘膜固有層と粘膜下層を中心に線維化が起こって最終的には食道狭窄がおこる疾患
• アミノ酸成分栄養食や特定の食品を除去することで、病理的、臨床的な改善を認めることからアレルギー性疾患と考えられている。

疫学

• 欧米では人口10万人に対して年間10例程度の新規発症
• 日本では20分の1以下の発症数と言われているが、最近の調査では胃カメラ施行1000人に1人の発見率であったという。
• 暖かい季節に後発し、アレルギー疾患を有している例が半数ある。男性が70-80%を占め、女性は少ない。発症年齢は30-50歳が後発。

症状

• 嚥下障害、胸のつかえ、胸痛、胸やけ
• 日本では症状が軽く、無症状の場合も少なくない。

検査

• 上部消化管内視鏡：縦走溝、ring、白斑が特徴的。生検で好酸球の浸潤を証明する(15以上/HPF)。
• 血液検査：末梢血好酸球増多(30%の例で見られる)、IgE高値(感度・特異度低い)

診断

• 胃カメラでの粘膜生検による。

治療

• 食事療法：

• 低脂肪食
• アレルゲン除去食：原因食材の同定が困難であることが多いため、小麦、ミルク、卵、大豆、ナッツ、海産物の6種の食材を除去した除去食が試され、有効率は70%である。ただし、継続は困難である。

• 薬物療法：

• プロトンポンプ阻害薬(高用量で8週間継続で60%の例で症状改善、内視鏡的にも改善したという)。不応例でもP-CABが奏効した例がある。
• フルチカゾンやブデソニドなどの局所作用ステロイド内服：フルタイドディスカスのブリスターを割り、粉末を口腔内に含み30分程度掛けて食道粘膜と接触させる。400-800μg分2。2-3ヶ月で70%程度の例で臨床的、内視鏡的に改善が得られる。
• ステロイド全身投与：

予後

• 15年程度で半数近くの例に食道の線維化に伴う狭窄が起こると言われている。

参考

• 日本内科学会雑誌 107巻3号p441

「eosinophilic」

　　[★]

• adj.

• 好酸球性の、好酸球の、好酸性の、好酸の、エオシン好性の、エオジン好性の

関

acidophil、acidophile、acidophilic、eosinophil