食管的「氣管化」

「Trachealization」 of the Esophagus

• Nandy N, Rustagi T. 「Trachealization」 of the Esophagus. New England Journal of Medicine 2019;380:177-.
• Corresponding toNina Nandy, M.D. Tarun Rustagi, M.D.University of New Mexico Albuquerque, NM tarunrustagi06@ gmail . com

A 32-year-old man presented to the emergency department with difficulty swallowing oral secretions and the feeling that food was stuck in his throat after he ate a pizza roll. The patient reported that similar episodes had occurred previously, but in each instance the feeling resolved spontaneously, and he did not seek medical care. At the time of presentation, the patient was drooling.

男性，32歲，因食披薩卷後，吞咽口腔分泌物困難伴食物梗阻感至急診就診。有類似疾病史，但均自行消退，未予重視。就診時，仍不斷流口水。

Upper endoscopy revealed impacted food material (Panel A) and prominent mucosal rings extending 20 cm from the incisors to the level of the gastroesophageal junction, with two discrete areas of narrowing and associated linear furrows (Panel B). Biopsy specimens were obtained, and esophagitis was observed, with more than 40 eosinophils per high-power field (Fig. S1 in the Supplementary Appendix).

胃鏡檢查發現梗阻食物（圖A）並且在門齒與胃食管交界水平之間存在明顯的粘膜環，長20厘米，產生兩個不連續的縮窄和隨之產生的線性溝(圖B)。活檢標本觀察到食管炎,每高倍視野超過40個嗜酸性粒細胞 (如上圖)。

An endoscopic finding of fixed esophageal rings, or 「trachealization,」 is suggestive of eosinophilic esophagitis, although a definitive diagnosis is made on the basis of clinical presentation, histologic findings, and the exclusion of other causes of esophageal eosinophilia, such as proton-pump inhibitor–responsive esophageal eosinophilia.

內鏡下發現的固定食管環，或「氣管化」，提示嗜酸性粒細胞性食管炎，不過最終的診斷還要基於臨床表現、組織學表現，並排除產生食管嗜酸性粒細胞的其他原因，如質子泵抑制反應的食管嗜酸性粒細胞。

The patient was treated with an 8-week course of omeprazole, but there was no symptom resolution or histologic improvement on repeat endoscopic biopsies, which confirmed the diagnosis of eosinophilic esophagitis. He was started on an 8-week course of both swallowed fluticasone and a six-food elimination diet (elimination of the six most commonly identified types of allergenic food — wheat, milk, soy, nuts, eggs, and seafood). No additional endoscopies were performed after completion of treatment with fluticasone and the elimination diet. At a 1-year follow-up visit, the patient reported no further symptoms of food impaction.

患者接受8周療程的奧美拉唑治療，但反覆內鏡活檢未見癥狀緩解或組織學改善，確診為嗜酸性食管炎。而後行8周的治療，包括口服氟替卡松和消除六種食物的飲食調控(消除六種最常見的過敏性食物——小麥、牛奶、大豆、堅果、雞蛋和海鮮)。在氟替卡松治療和飲食種類控制結束後，沒有再進行內鏡檢查。隨訪1年，患者未再有食物嵌塞的進一步癥狀。

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