Yutma Güçlüğünün Sık Düşünülmeyen Tanısı; Eozinofilik Özofajit

Yıl 2015, Cilt: 13 Sayı: 2, 155 - 158, 01.09.2015

Mehmet Ağın Gökhan Tümgör Nilgün Uyduran Ünal Serdar İskit Figen Doran

https://doi.org/10.4274/jcp.84755

Öz

Eozinofilik özofajit, özofagus mukozasının eozinofil lökositler ile infiltrasyonudur. Çocuklarda nadir görülür ve bulguları gastroözofageal reflü ile benzerdir. Yutma güçlüğü nedeni ile çocuk cerrahisinde özofagus balon dilatasyonu uygulanan ve eozinofilik özofajit olduğu saptanan bu olgu disfajili çocuğa yaklaşıma dikkat çekmek amacı ile sunulmuştur. Toplam IgE=834 IU/mL ve spesifik IgE - , Fx5 - negatif saptandı. Üst gastrointestinal sistem endoskopisinde özofagusun mukozasının soluk, yapısının sert, motilitesinin bozuk olduğu gözlendi ve birkaç adet milimetrik beyaz lezyonlar görüldü. Özofagus biyopsi materyallerinde mukozada eozinofil infiltrasyonun %60 oranında olduğu gözlendi. Olguya eozinofilik özofajit tanısı ile oral prednizolon 1 mg/kg/gün başlandı. Olgunun bir hafta sonraki poliklinik kontrolünde disfaji yakınmalarında belirgin düzelme olduğu ve birinci ay kontrolünde hiçbir yakınmasının olmadığı gözlendi. Disfaji ve reflü benzeri semptomlarda özellikle gastroözofageal reflü tedavisine yanıt alınamıyorsa eozinofilik özofajit tanısı mutlaka dikkate alınmalıdır

Anahtar Kelimeler

Disfaji, eozinofilik, özofajit, gastroözefageal reflü, çocuk

A Non-Frequently Considered Diagnosis of Dysphagia; Eosinophilic Esophagitis

Öz

Eosinophilic Esophagitis is infiltration of esophagus mucosa by eosinophil leucocyte. It is rarely observed in children and the symptoms are similar to gastroesophageal reflux. This case, which was applied esophagus balloon dilatation in the pediatric surgery due to dysphagia and diagnosed eosinophilic esophagitis, was presented in order to attract attention to the approach to the child with dysphagia. Total IgE=834 IU/mL and specific IgE - , Fx5 - was found negative. In the upper GIS endoscopy, it was observed that esophagus mucosa was pale, its structure was hard and its motility was disordered and a couple milimetric white lesions were observed as well. In the esophagus biopsy materials, it was observed that the eosinophil infiltration in the mucosa was 60%. With the diagnosis of Eosinophilic Esophagitis, the case was started on oral prednisolone 1 mg/kg/day. In the polyclinic control of the case after a week, it was observed that there was a significant decrease in the complaints about dysphagia and in the one-month control the complaints were all gone. In the symptoms similar to dysphagia and reflux, especially if the case is not responding to gastroesophageal reflux treatment, the diagnosis of Eosinophilic Esophagitis should absolutely be considered

Anahtar Kelimeler

Dysphagia, eosinophilic, esophagitis, gastroesophageal reflux, child

Kaynakça

• 1. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3-20.
• 2. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342-63.
• 3. Francavilla R, Leone G, Fico S, Fontana C, Castellaneta S, Piscitelli D, et al. PA16 celiac disease and eosinophilic esophagitis: is there an association? Dig Liver Dis 2009;(Suppl 3):41:228.
• 4. Dalby K, Nielsen RG, Kruse-Andersen S, Fenger C, BindslevJensen C, Ljungberg S, et al. Eosinophilic oesopha gitis in infants and children in the region of southern Denmark: a prospective study of prevalence and clinical presentation. J Pediatr Gastroenterol Nutr 2010;51:280-2.
• 5. Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 2002;109:363- 8.
• 6. Spergel JM, Andrews T, Brown-Whitehorn TF, Beausoleil JL, Liacouras CA. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol 2005;95:336-43.
• 7. Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol 2005;3:1198-206.
• 8. Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med 2004;351:940-1.
• 9. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic rewiew and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342-63.
• 10. Aceves SS, Newbury RO, Dohil MA, Bastian JF, Dohil R. A symptom scoring tool for identifying pediatric patients with eosinophilic esophagitis and correlating symptoms with inflammation. Ann Allergy Asthma Immunol 2009;103:401-6.
• 11. Aceves SS, Newbury RO, Dohil R, etal. Distinguishing eosinophilic esophagitis in pediatric patients: clinical, endoscopic, and histologic features of an emerging disorder. J Clin Gastroenterol 2007;41:252-6.
• 12. Hurtado CW, Furuta GT, Kramer RE. Etiology of esophageal food impactions in children. J Pediatr Gastroenterol Nutr 2011;52:43- 6.
• 13. Cheung KM, Oliver MR, Cameron DJ, Catto-Smith AG, Chow CW. Esophageal eosinophilia in children with dysphagia. J Pediatr Gastroenterol Nutr 2003;37:498-503.
• 14. Prasad GA, Alexander JA, Schleck CD, Zinsmeister AR, Smyrk TC, Elias RM, et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol 2009;7:1055-61. 15. Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, et al. Eosinophilic esophagitis: a 10 year experience in 381 children. Clin Gastroenterol Hepatol 2005;3:1198-206.
• 16. Prasad GA, Talley NJ, Romero Y, Arora AS, Kryzer LA, Smyrk TC, et al. Prevelence and predictive factors of eosinophilic esophagitis, in patients presenting with dysphagia: a prospective study. Am J Gastroenterol 2007;102:2627-32.
• 17. Guajardo JR, Plotnick LM, Fende JM, Collins MH, Putnam PE, Rohegberg ME. Eosinophil associated gastrointestinal disorders: a world-wide-web based registry. J Pediatr 2002;141:576-81.
• 18. Strauman A, Hruz P. What’s new in the diagnosis and therapy of eosinophilic esophagitis? Curr Opin Gastroenterol 2009;25:366- 71.
• 19. Teitelbaum JE, Fox VL, Twarog FJ, Nurko S, Antonioli D, Gleich G, et al. Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 2002;122:1216-25.
• 20. Schaefer ET, Fitzgerald JF, Molleston JP, Croffie JM, Pfefferkorn MD, Corkins MR, et al. Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis; a randomized trial in children. Clin Gastroenterol Hepatol 2008;6:165-73.