ステロイド治療が有効であったびまん性食道痙攣症の1例  [in Japanese] A case of diffuse esophageal spasm successfully treated by steroid therapy  [in Japanese]

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Author(s)

    • 舟木 康 FUNAKI Yasushi
    • 愛知医科大学内科学講座消化器内科(消化管部門)|愛知医科大学病院中央臨床検査部 Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine|Division of Laboratory Medicine, Aichi Medical University Hospital
    • 春日井 邦夫 KASUGAI Kunio
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine
    • 飯田 章人 IIDA Akihito
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine
    • 下郷 彰礼 SHIMOZATO Akihiro
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine
    • 山口 純治 YAMAGUCHI Junji
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine
    • 田邉 敦資 TANABE Atsushi
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine
    • 田村 泰弘 TAMURA Yasuhiro
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine
    • 井澤 晋也 IZAWA Shinya
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine
    • 小笠原 尚高 OGASAWARA Naotaka
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine
    • 佐々木 誠人 SASAKI Makoto
    • 愛知医科大学内科学講座消化器内科(消化管部門) Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine

Abstract

症例は53歳,男性.食道のつかえ感,嚥下痛から食事摂取も困難となり入院.食道内圧検査にて正常の蠕動波と,非蠕動性で同期性の強収縮波を20%以上に認めた.また非蠕動の強収縮に一致した強い胸痛の訴えから,びまん性食道痙攣症と考えた.画像所見にて全周性の食道壁肥厚と血液検査で好酸球とIgEの上昇を認めたため,アレルギーの関与を考えステロイド治療を開始したところ,症状は著明に改善し食道壁肥厚も軽減した.

A 53-year-old man was admitted to our hospital with anterior chest pain and difficulty swallowing. Computed tomography revealed significant esophageal wall thickening. Esophageal intraluminal manometry revealed uncoordinated contraction and strong peristaltic pressure associated with the chest pain. The patient was subsequently diagnosed with diffuse esophageal spasm (DES). His serum immunoglobulin E level was high, and peripheral blood eosinophilia was observed. No eosinophilic infiltration was detected in the esophageal mucosa on endoscopic biopsy. It was presumed that this case of DES was induced by allergic disease. Treatment with 30 mg of oral prednisolone led to a prompt resolution of symptoms;the thickness of the esophageal wall decreased, and the simultaneous contractions disappeared. However, given the presence of a strong peristaltic wave, nutcracker esophagus (NE) was also suspected. This was a rare case of atypical DES induced by allergic disease and associated with NE.

Journal

  • Nippon Shokakibyo Gakkai Zasshi

    Nippon Shokakibyo Gakkai Zasshi 111(9), 1774-1781, 2014

    The Japanese Society of Gastroenterology

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