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[È£»ê±¸¼º À§¿°. eosinophilic gastritis] - ðû

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1. Introduction

2. Work up for hypereosinophilia - 2015³â SMC ¾Ë·¹¸£±â³»°ú

3. ´ëÇ¥Àû Áõ·Ê - 2018³â 4¿ù 21ÀÏ ¼øõ¸¸³»½Ã°æ¼¼¹Ì³ª¿¡¼­ ¹ßÇ¥µÈ È£»ê±¸¼º À§¿° (¹ßÇ¥ÀÚ: ¾È¿ëȯ)°ú ÀÌÁØÇà comment

4. ¿Ì¿¡ ÀÇÇÑ eosinophilic gastroenteritis - Clinical Endoscopy 2015

5. FAQ

6. References


1. Introduction

È£»ê±¸ À§¿° eosinophilic gastritisÀº ¶Ñ·ÇÈ÷ Á¤ÀǵÇÁö ¾ÊÀº ÁúȯÀÔ´Ï´Ù. È£»ê±¸ À§Àå¿° eosinophilic gastroenteritis³ª È£»ê±¸ ½Äµµ¿° eosinophilic esophagitis¿¡ ´ëÇÑ °ü½É°ú ¿¬±¸ ¹× ȯÀÚµéÀº ¸¹À¸³ª À§¿¡ ±¹ÇÑµÈ È£»ê±¸¼º À§¿° ȯÀÚ´Â °ÅÀÇ º¸±â ¾î·Æ½À´Ï´Ù. ¸î °³ÀÇ Èï¹Ì·Î¿î Áõ·ÊµéÀÌ ¹®Çå¿¡ º¸°íµÇ°Å³ª Çмú¸ðÀÓ¿¡¼­ ³íÀǵǰí ÀÖÀ» »ÓÀÔ´Ï´Ù.

Á¤»ó À§Á¡¸·¿¡´Â ¾î´À Á¤µµÀÇ È£»ê±¸°¡ Á¸ÀçÇϸç Helicobacter ¾ç¼º À§Á¡¸·¿¡´Â ¾à°£ ´õ ¸¹Àº È£»ê±¸°¡ ÀÖ½À´Ï´Ù (Mod Pathol 2011). ¾ó¸¶³ª ¸¹Àº È£»ê±¸°¡ °üÂûµÇ¾î¾ß ÀÓ»óÀû ÀÇÀÇ°¡ ÀÖ´ÂÁö ºÒ¸íÈ®ÇÕ´Ï´Ù. À§ ¹®Çå(Mod Pathol 2011)¿¡´Â ¾Æ·¡¿Í °°ÀÌ ¾ð±ÞµÇ¾î ÀÖ½À´Ï´Ù.

This study confirms that, in the United States population, the normal gastric eosinophilic counts are usually <38 eosinophils/mm(2). We recommend 'histological eosinophilic gastritis' for the diagnosis of gastric biopsies that show an average density ¡Ã127 eosinophils/mm(2) (or ¡Ã30 eosinophils per HPF) in at least five HPFs in the absence of known associated causes of eosinophilia.

¿©·¯ °Ë»ç¸¦ ÅëÇÏ¿© ´Ù¸¥ ÁúȯÀÌ ¾ø´Ù¸é °æ±¸ ½ºÅ×·ÎÀ̵å(¿¹: 20-30mg/day for 2 weeks ÈÄ Á¡Â÷ °¨·®)¿¡ ¹ÝÀÀÀ» º¸Àδٰí ÇÕ´Ï´Ù. Àú´Â allergy ³»°ú¿¡ ÀÇ·ÚÇÏ¿© ¸î °¡Áö °Ë»ç¸¦ ÇÏ°í ±× °÷¿¡¼­ Ä¡·á¹Þµµ·Ï ±ÇÇÏ°í ÀÖ½À´Ï´Ù.


[ACG Virtual Grand Round (Kathy A Peterson) Facebook ±×¸² (2020-6-26)]


2. Work up for hypereosinophilia (2015³â SMC ¾Ë·¹¸£±â³»°ú)

Alcohol :
Smoking :
¾Ë·¯Áö º´·Â :
¾Ö¿Ï µ¿¹° º´·Â :
»ý½Ä·Â (À°È¸, °£Ãµ¿±, »ç½¿ÇÇ, ¹Î¹°È¸) :
Medication ¿Ïº®È÷ ÆľÇÇϱâ :

Body weight gain À¯¹«
Skin rash / photosensitivity / easy bruising (-/-/-)
Dry eye / dry mouth (-/-)
Oral ulcer / genital ulcer (-/-)
Arthralgia / joint swelling (-/-)
Raynaud phenomenon (-)

Neurologic symptom ÀÌ ÀÖ´ÂÁöµµ ¸Å¿ì Áß¿ä

CBC with differential count
ECP :
Eosinophil count :
Serum total IgE :
Toxocaris Ab IgG titer (¹Ýµå½Ã comment ¿¡ "À½¼º ´ëÁ¶±º ¹× ¾ç¼º ´ëÁ¶±º OD °ªµµ ¾Ë·ÁÁÖ¼¼¿ä" ¶ó°í ³²°Ü¼­ order ³Ö±â)
Parasite Ab (ELISA):
Stool exam (ÃÑ 3ȸ) :


3. 2018³â 4¿ù 21ÀÏ ¼øõ¸¸³»½Ã°æ¼¼¹Ì³ª¿¡¼­ ¹ßÇ¥µÈ È£»ê±¸¼º À§¿° (¹ßÇ¥ÀÚ: ¾È¿ëȯ)°ú ÀÌÁØÇàÀÇ comment

ÇÑ´Þ°£ÀÇ postprandial discomfort¿Í heartburnÀ¸·Î ³»½Ã°æÀ» ½ÃÇàÇÏ¿© large nodular typeÀÇ lymphofollicular gastritis¸¦ ÀǽÉÇÏ¿´À¸³ª Á¶Á÷°Ë»ç¿¡¼­ eosinophilic gastritisÀÇ ¼Ò°ßÀ̾úÀ½. Helicobacter Á¦±ÕÄ¡·á¸¦ ÇÏ¿´À¸³ª È£ÀüÀÌ ¾ø¾ú°í, ÀÇ·ÚÇÏ¿© steroid Ä¡·á¸¦ ¹ÞÀº ÈÄ È£ÀüµÇ¾úÀ½.

CLOtest (+)·Î Á¦±ÕÄ¡·á¸¦ ÇÏ¿´°í ÃßÀû ³»½Ã°æ¿¡¼­µµ È£ÀüÀÌ ¾ø¾úÀ½.

Steroid »ç¿ë ÈÄ È£ÀüµÇ¾ú½À´Ï´Ù.

¾È¿ëȯ ¼±»ý´ÔÀº eosinophilic gastroenteritis´Â rareÇϱ⺸´Ù´Â uncommon ÇÏ´Ù´Â Á¤µµ·Î »ý°¢À» ¹Ù²ã¾ß ÇÑ´Ù°í ÁÖÀåÇϼ̽À´Ï´Ù.

Take home message
Uncommon and heterogeneous disease
High degree of clinical suspicion is especially necessary.  


[2018-4-21. ÀÌÁØÇà comment]

È£»ê±¸¼º À§Àå°ü¿°Àº ÃÖ±Ù Á¶±Ý¾¿ Áõ°¡ÇÏ°í ÀÖ´Â ÁúȯÀ¸·Î Á¡¸·Çü, ±ÙÃþÇü, À帷ÇüÀ¸·Î ºÐ·ùµË´Ï´Ù. ¿øÀÎÀº ¸íÈ®ÇÏÁö ¾ÊÀ¸³ª allergy¼ºÀÏ °ÍÀ¸·Î ÃßÁ¤ÇÏ°í ÀÖ½À´Ï´Ù. ½ÉÇÑ Áõ·Ê´Â ´ëºÎºÐ ¼ÒÀå¿¡¼­ ¹ß»ýÇÏ°í ÀÖÁö¸¸, È£»ê±¸¼º À§¿°µµ µå¹°°Ô Áø´ÜµÇ´Â °Í °°½À´Ï´Ù. ´ëÇÑ»óºÎÀ§Àå°ü,Ç︮ÄÚ¹ÚÅÍÇÐȸ 2018³â 2¿ù ±³À°ÀÚ·á·Î ¼Ò°³µÈ ¹Ù ÀÖ½À´Ï´Ù

2018³â 2¿ù ±³À°ÀÚ·á. ½ºÅ×·ÎÀÌµå »ç¿ë ÈÄ È£ÀüµÇ¾ú´ø Áõ·Ê.

Àú´Â È£»ê±¸¼º À§Àå°ü¿°À¸·Î ÆǴܵǸé allergy ³»°ú·Î º¸³» °Ë»ç¸¦ ÇÏ°í ÀÖ½À´Ï´Ù¸¸, ¿øÀÎ allerginÀÌ ±Ô¸íµÇ´Â °æ¿ì´Â °ÅÀÇ ¾ø¾ú½À´Ï´Ù. ´ÙÇེ·´°Ô ½ºÅ×·ÎÀÌµå ¹ÝÀÀÀº ÁÁÀº ÆíÀÔ´Ï´Ù.

Áß¿äÇÑ °ÍÀº °¨º°Áø´ÜÀÔ´Ï´Ù. È£»ê±¸¼º À§¿°À¸·Î Áø´ÜÇϱâ À§Çؼ­´Â º¸¸¸ 4Çü ÁøÇ༺ À§¾Ï, ¸²ÇÁÁ¾, ¸Åµ¶, ºÐ¼±ÃæÁõ µîÀº ¾Æ´ÑÁö ÁÖÀÇÇÏ´Â °ÍÀÌ ÁÁ½À´Ï´Ù. 2008³â ºó¼¾Æ®º´¿ø¿¡¼­´Â Á¶Á÷°Ë»ç¿Í EMR º´¸® ¼Ò°ß ÀǰŠȣ»ê±¸¼º À§¿°À¸·Î ÃßÁ¤ÇÏ¿´À¸³ª ¼ö¼ú ÈÄ º¸¸¸ 4Çü ÁøÇ༺ À§¾ÏÀ¸·Î Áø´ÜÇÏ¿´´ø ȯÀÚ¸¦ º¸°íÇÑ ¹Ù ÀÖ½À´Ï´Ù.

´ëÇѼÒÈ­±â³»½Ã°æÇÐȸÁö 2008

À§ Áõ·Ê º¸°íÀÇ °íÂû

µå¹°Áö¸¸ ±â»ýÃæÁõµµ ¹èÁ¦ÇØ¾ß ÇÕ´Ï´Ù. ƯÈ÷ ºÐ¼±ÃæÁõÀº Áß¿äÇÕ´Ï´Ù. ÀúÈñ ÆÀ¿¡¼­ ¼ö ³â Àü ÇÑ´Þ°£ÀÇ À§ÀåÁõ¼¼·Î ³»¿øÇÏ°í ¾à°£ÀÇ peripheral eosinophilia°¡ ÀÖ´ø ȯÀÚÀÇ À§ Á¶Á÷°Ë»ç¿¡¼­ ºÐ¼±ÃæÀ» È®ÀÎÇÏ°í Ä¡·áÇÏ¿© Áõ·Êº¸°íÇÑ Àûµµ ÀÖ½À´Ï´Ù. ºÐ¼±ÃæÁõÀÌ Á¤È®È÷ Áø´ÜµÇÁö ¾ÊÀº »óÅ¿¡¼­ steroid°¡ Åõ¾àµÇ¸é ȯÀÚ°¡ »ç¸ÁÇϱ⵵ ÇϹǷΠ±ØÈ÷ ÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. Hypereosinophilic syndromeÀ̶ó°í ÇÕ´Ï´Ù.

¸¶Áö¸·À¸·Î ¿ÏÀüÈ÷ Á¦ °³ÀÎ ÀÇ°ßÀÌÁö¸¸ EoE³ª eosinophilic gastroenteritisÀÇ Áõ°¡ ¿øÀÎÀ¸·Î ½Äǰ÷°¡¹°À» ÀǽÉÇÏ°í ÀÖ½À´Ï´Ù. ¹º°¡ÀÇ È¯°æÀû ¿äÀÎÀÌ ÀÖ´Â °ÍÀº Ʋ¸² ¾ø½À´Ï´Ù.


4. ¿Ì¿¡ ÀÇÇÑ eosinophilic gastroenteritis

2015³â 3¿ùÈ£ Clinical EndoscopyÁö¿¡ ¿Ì (Rhus tree)¿¡ ÀÇÇÑ ESD ÈÄ À§Àå°ü ÃâÇ÷·Î ¹ßÇöµÈ eosinophilic gastroenteritis Áõ·Êº¸°í°¡ ÀÖ¾ú½À´Ï´Ù (¸µÅ©).

ÀÚ¼¼ÇÑ º´·ÂûÃë°¡ Áß¿äÇÒ °Í °°½À´Ï´Ù. ³í¹®¿¡´Â "She ingested Rhus extract 2 days prior."¶ó°í ¾º¿© ÀÖ¾ú´Âµ¥ ¿ÌÀ» ¾î¶»°Ô ÁغñÇÏ¿© ¾î¶»°Ô ¾î´À Á¤µµ µå¼Ì´ÂÁö ¾Ë ¼ö ¾ø¾ú½À´Ï´Ù. (¿µ¾î·Î ³í¹®À» ¾²¸é ÀÌ·± °ÍÀÌ Àß µÇÁö ¾Ê½À´Ï´Ù. ´µ¾Ó½º³ª ¹Ì¼¼ÇÑ Ç¥ÇöÀ» ¿µ¾î·Î´Â ¾î·Æ±â ¶§¹®ÀÔ´Ï´Ù. ¿ì¸®¸»·Î Áõ·Êº¸°í°¡ µÇ¾ú´Ù¸é ´õ ÁÁ¾ÒÀ» °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù. ¾Æ½±½À´Ï´Ù. ¿µ¾î ³í¹®Àº ÁÁÀº ³í¹®ÀÌ°í ¿ì¸®¸» ³í¹®Àº ÈÄÁø ³í¹®À¸·Î °£ÁÖÇÏ´Â Çö ¼¼Å°¡ ÇÑź½º·´½À´Ï´Ù.) ¿©ÇÏÆ° °á·ÐÀº ´ÙÀ½°ú °°¾Ò½À´Ï´Ù. "We concluded that the Rhus extract provoked a type IV hypersensitivity reaction on the skin, and that it may be the allergen causing EGE. After avoidance of the allergen, the patient's symptoms remitted."


[FAQ]

[2013-3. ¾Öµ¶ÀÚ Áú¹®]

¾È³çÇϽʴϱî. ¿£µµÅõµ¥À̸¦ ½º¸¶Æ®ÆùÀ¸·Î ¹Þ¾Æº¸¸ç ÃâÅð±Ù±æ¸¶´Ù Àо°ï ÇÕ´Ï´Ù. Àü°øÀÇ ¶§ ¹ÞÀº ÁÁÀº ¼ö·ÃÀ» °è¼Ó ÀØ°Ô µÇ´Âµ¥ ±×³ª¸¶ ±³¼ö´ÔÀÇ ¿£µµÅõµ¥ÀÌ°¡ ¸¹Àº µµ¿òÀÌ µË´Ï´Ù.

¿À´Ã ¸ÞÀÏÀ» ¿Ã¸®´Â ÀÌÀ¯´Â Àǹ®³ª´Â Á¡ÀÌ À־ÀÔ´Ï´Ù. ¿À´Ã º¸³» ÁֽŠ°Í¿¡¼­ '½ºÅ×·ÎÀ̵带 »ç¿ëÇϱâ Àü ±â»ýÃæ¾àÀ» ¸ÕÀú ¾²ÀÚ´Â ÀúÀÇ ÁÖÀå¿¡ ´ëÇÏ¿© ¾Ë·¯Áö³ª °¨¿°³»°ú Àü¹®°¡µéÀº ´ëºÎºÐ µ¿ÀÇÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù. ±×·¸´õ¶óµµ history taking°ú ±âÃÊÀû °Ë»çÀ» ¿­½ÉÈ÷ ±×¸®°í Àß Çϱ⸦ °£ÀýÈ÷ ±â¿øÇÕ´Ï´Ù.'¶ó´Â ´ë¸ñ¿¡ ´ëÇÑ °ÍÀÔ´Ï´Ù. Àúµµ ±³¼ö´ÔÀÇ ÁÖÀå¿¡ °ø°¨ÇÏ°í ÀÖ½À´Ï´Ù. ±× ÀÌÀ¯´Â ±â»ýÃæ¾àÀº º¸Åë »ç¿ë ±â°£ÀÌ µü 1ȸÀÎ °æ¿ìµµ ¸¹°í ±×·¸Áö ¾Ê´õ¶óµµ ±â°£ÀÌ Âª½À´Ï´Ù. ºÎÀÛ¿ëµµ ±â»ýÃæ¾àÀÌ ½ºÅ×·ÎÀ̵庸´Ù Àû½À´Ï´Ù. ¸¶Áö¸·À¸·Î ±â»ýÃæ¾àÀ» ½á¹ö¸®´Â °ÍÀÌ ºÐ¼±ÃæÁõ °Ë»çº¸´Ù ½Î°í ȯÀÚÀÇ ºÒÆí°¨µµ ´úÇÕ´Ï´Ù.

¾Ë·¯Áö³ª °¨¿° ¼±»ý´ÔµéÀÌ µ¿ÀÇÇÏÁö ¾Ê´Â °Í¿¡´Â ºÐ¸í ÀÌÀ¯°¡ ÀÖÀ» °ÍÀÔ´Ï´Ù. Ȥ½Ã ±×ºÐµéÀÌ ±³¼ö´Ô°ú ÀúÀÇ »ý°¢¿¡ µ¿ÀÇÇÏÁö ¾ÊÀ¸½Ã´Â ±Ù°Å¸¦ ¼Ò°³ÇØ ÁÖ½Ç ¼ö ÀÖÀ»±î¿ä?

[2013-3. ÀÌÁØÇà ´äº¯]

ÃæºÐÇÑ Åä·ÐÀÌ ºÎÁ·ÇÏ¿© Àúµµ Á¤È®È÷ »ý°¢À» Á¤¸®ÇÏÁö ¸øÇß½À´Ï´Ù. ¸ÕÀú ¸íÈ®È÷ ¹àÈü´Ï´Ù. ¾àÀ» ¾²ÀÚ´Â °ÍÀº °Ë»ç¸¦ ÇÏÁö ¸»ÀÚ´Â ¶æÀÌ ¾Æ´Õ´Ï´Ù. ºÐ¼±ÃæÁõÀ» ¹èÁ¦Çϱâ À§ÇÑ ÃæºÐÇÑ °Ë»ç´Â ºÐ¸íÈ÷ ½ÃÇàµÇ¾î¾ß ÇÕ´Ï´Ù. ±×·³¿¡µµ ºÒ±¸ÇÏ°í steroid »ç¿ë Àü ±â»ýÃæ¾àÀ» ½á º¸ÀÚ´Â Àǹ̿´½À´Ï´Ù.

(1) Ȥ½Ã ³»°úÀÇ»çµéÀÇ ±âº»ÀûÀΠŵµ °°Àº °Í ¾Æ´Ò±î »ý°¢ÇÕ´Ï´Ù. Á¤È®ÇÑ Áø´ÜÀ» ã¾Æ¼­ Á¤È®È÷ Ä¡·áÇÏ´Â °ÍÀº ³»°úÀÇ»çÀÇ ¹Ì´öÀÔ´Ï´Ù. Àúµµ ±×·¸°Ô ¹è¿ü½À´Ï´Ù. ÃÖ±Ù ÀϺΠ¼±»ý´ÔµéÀÌ hypereosinophilia¿¡¼­ steroid ó¹æ Àü albendazoleÀ» 3ÀÏ Á¤µµ »ç¿ëÇÏ´Â protocolÀ» °¡Áö°í ÀÖ´Ù´Â ¼Ò¹®ÀÌ µé¸³´Ï´Ù. Àú´Â Âù¼ºÇÕ´Ï´Ù.

(2) »ç½Ç ºÐ¼±ÃæÁõÀº ÁÁÀº Ä¡·á¾àÀÌ ¾ø½À´Ï´Ù (Âü°í: ¼ÒÈ­±â±â»ýÃæ Ç¥ÁØó¹æ). Treatment of choice´Â thiabendazoleÀε¥ ±¸Çϱ⠾î·Æ°í ºÎÀÛ¿ëµµ ¸¹½À´Ï´Ù. Èñ±ÍÀǾàÇ°¼¾ÅÍ(ȤÀº ±¹¸³ÀÇ·á¿ø)¿¡¼­ ¹Þ¾Æ¾ß ÇϹǷΠÁ¤È®ÇÑ Áø´Ü ±Ù°Å°¡ ÇÊ¿äÇÕ´Ï´Ù. ½Å¾àÀ¸·Î´Â ivermectinÀÌ Àִµ¥ ±¸Çϱ⠾î·Æ°í »ç¿ëÇØ º» ÀûÀÌ ¾ø½À´Ï´Ù. ¾î¿ ¼ö ¾øÀÌ albendazoleÀ» 3ÀÏ »ç¿ëÇÏ°ï ÇÕ´Ï´Ù. È¿°ú´Â ½ÅÅëÄ¡ ¾ÊÀ» ¶§µµ ÀÖ½À´Ï´Ù. 2011³â 4¿ù 3ÀÏ EndoTODAY¿¡¼­ ¼Ò°³ÇÑ ÀڷḦ ¿Å±é´Ï´Ù. ¾à°£ ¹Ù²î¾úÀ»Áöµµ ¸ð¸¨´Ï´Ù.

"Ä¡·áÈ¿°ú´Â thiabendazoleÀÌ °¡Àå ÁÁÀºµ¥ ºÎÀÛ¿ëÀÌ ¸¹´Ù´Â ´ÜÁ¡ÀÌ ÀÖ½À´Ï´Ù. ÇöÀçÀÇ treatment of choice´Â ivermectinÀ¸·Î Á¤¸®µÈ °Í °°½À´Ï´Ù. 95% ÀÌ»ó È¿°ú°¡ ÀÖÀ¸¸é¼­ ºÎÀÛ¿ëÀÇ ºóµµ´Â ÈξÀ ³·½À´Ï´Ù.

¿©·¯ºÐÀÌ ¸¹ÀÌ º¸½Ã´Â emedicine.medscape.com¿¡´Â "Ivermectin (Stromectol). Binds to glutamate-gated chloride ion channels in invertebrate nerve and muscle cells. Increased permeability of the cell membrane occurs with hyperpolarization, resulting in paralysis and death of the parasite. Effective against adult intestinal strongyloides. Cure rate is 97% with 2-day course. Case reports have been made of successful SC injection of ivermectin in patients unable to achieve adequate serum drug levels after oral administration"¶ó°í µÇ¾î ÀÖ½À´Ï´Ù.

º» º´¿ø ¾àÁ¦°ú¿¡ ¹®ÀÇÇÑ ¹Ù ´ÙÀ½°ú °°Àº ´äº¯À» ¹Þ¾Ò½À´Ï´Ù. 'Thiabendazole, ivermectinÀº Èñ±ÍÀǾàÇ°¼¾ÅÍ¿¡¼­´Â °ø±ÞµÇ°í ÀÖÁö ¾Ê½À´Ï´Ù. ÇöÀç ±¹¸³ÀÇ·á¿ø¿¡¼­ ¾àÀ» ±¸ÇÒ ¼ö ÀÖ½À´Ï´Ù. ±¹¸³ÀÇ·á¿ø¿¡¼­´Â 'ÇØ¿ÜÀ¯ÀÔÀü¿°º´°ü¸®±ÔÁ¤'¿¡ µû¶ó Áúº´°ü¸®º»ºÎ¿¡¼­ ±¸¸Å ¹× °ø±ÞÇÏ°í ÀÖ´Â ±¹³» ºñÃà¿ë ÇØ¿ÜÀ¯ÀÔÀü¿°º´Ä¡·á¾à ÁöÁ¤¸ñ·ÏÀ» Åõ¾àÇÏ°í ÀÖ½À´Ï´Ù. ±¹¸³ÀÇ·á¿ø ¾àÁ¦°ú 2260-7389'"


[2015-10-8. ¾Öµ¶ÀÚ Áú¹®]

Á߳⠳²¼ºÀÔ´Ï´Ù. CardiaºÎÅÍ midbody±îÁöÀÇ ¼Ò¸¸ÂÊ º´¼ÒÀÔ´Ï´Ù. ƯÈ÷ cardia º´º¯ÀÌ Å©±â°¡ Å©°í ¹º°¡ ¿µ ÂòÂòÇغ¸ÀÌ´Â ¸ð¾çÀÔ´Ï´Ù.»öÁ¶µµ ºÒ±ÕÁúÇÏ°í, edgeµµ ºÒ±ÔÄ¢ÇÏ°í, »çÀÌ»çÀÌ¿¡ exudateµµ »ì¦ ³¢¾îÀÖ½À´Ï´Ù. ºñ±³Àû flat ÇÏÁö¸¸ diffuseÇÑ Å¸ÀÔÀÔ´Ï´Ù. À۳⠻çÁø¿¡´Â Áö±Ý °°Àº º´º¯Àº º¸ÀÌÁö ¾Ê¾Ò½À´Ï´Ù. »çÁøÀÇ µÎ °÷¿¡¼­ Á¶Á÷°Ë»ç Çߴµ¥ °á°ú´Â ´ÙÀ½°ú °°½À´Ï´Ù.

A) Cardia. Erosion with chronic active gastritis, with
1) regenerative glands
2) focal lymphoid cells aggregation
3) prominent eosinophils infiltration in lamina propria ( > 20 / 40 HPF)
**microscopic findings by Sydney system ;
1. Neutrophils : moderate
2. Mononuclear cells : moderate
3. Atrophy : absent
4. Intestinal metaplasia : absent

B) Mid body, lesser curvature. Erosion with chronic atrophic gastritis, active, and some prominent eosinophils infiltration in lamina propria ( 15-20 / 40 HPF)
**microscopic findings by Sydney system ;
1. Neutrophils : moderate
2. Mononuclear cells : mild
3. Atrophy : mild
4. Intestinal metaplasia : absent
Note : Esosinophils are relatively prominently infiltrated in lamina propria. The possibility of eosinophilic (allergic) gastritis is suspicious.

CBC´Â 6900-16.4/45.9-148k Àε¥ eosinophilsÀÌ 20%¿´½À´Ï´Ù. Èí¿¬ÀÚ(1/2pack/day x 20yr)ÀÌ°í À½ÁÖ´Â 1ÁÖÀÏ¿¡ ÇÏ·ç ¸ÆÁÖ ÇÑ º´ Á¤µµÀÔ´Ï´Ù. Chest PA»ó ƯÀ̼ҰßÀÌ ¾ø°í º¹ºÎÃÊÀ½ÆÄ¿¡¼­´Â fatty liver¿Í benign À¸·Î º¸¿©Áö´Â hepatic noduleÀÌ ÀÖ½À´Ï´Ù.

Eosinophilic gastritis °Ë»öÇØ º¸¾Ò½À´Ï´Ù. Èñ±ÍÇÑ ÄÉÀ̽º º¸°íµÈ °ÍµéÀº Á» º¸À̴µ¥, ¾ÆÁ÷ µüºÎ·¯Áö°Ô ÀÌ°Å´Ù ½ÍÀº ÀÚ·á´Â Á¦°¡ ¾ÆÁ÷ ÃæºÐÈ÷ °Ë»öÀ» ¸øÇؼ­ÀÎÁö ãÁö ¸øÇÑ »óÅÂÀÔ´Ï´Ù.

[2015-5. EndoTODAY °ø°³Áú¹®À» ÅëÇØ ¹ÞÀº ÇÑ Àü¹®°¡ÀÇ ´äº¯]

¸ð¾çÀº ¸¶Ä¡ MALT lymphoma °°Áö¸¸, pph. eosinophlia°¡ ÀÖ°í Á¶Á÷°Ë»ç»ó eosinophilic infiltrationÀÌ ÀÖÀ¸´Ï, È£»ê±¸¼º À§¿°ÀÌ ¸Â´Ù°í »ý°¢ÇÕ´Ï´Ù. ÀÌ¿¡ ´ëÇÑ ½ºÅ×·ÎÀ̵å Ä¡·á ÈÄ¿¡ ÃßÀû°Ë»ç¸¦ Çؼ­ »ç¶óÁø °ÍÀÌ È®ÀεǸé È®ÁøÇÒ ¼ö ÀÖÀ¸¸®¶ó »ý°¢ÇÕ´Ï´Ù.

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¾î·Á¿î Áõ·ÊÀÔ´Ï´Ù. ¸»¾¸ÁֽŠ¹Ù¿Í °°ÀÌ (1) CBC with diff (peripheral eosinophilia ¿©ºÎ È®ÀÎ), ESR, IgE °Ë»ç, (2) ±â»ýÃæ °¨º° À§ÇÑ stool examÀ» ÇÏ´Â °ÍÀº ÁÁÀº ¼±ÅÃÀÔ´Ï´Ù. ±×·¯³ª ´õ ÀÌ»óÀÇ °Ë»çº¸´Ù´Â Áõ»óÀÌ ½ÉÇÏÁö ¾Ê´Ù¸é ÀÏ´Ü Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÈÄ ÃßÀû³»½Ã°æ ¹× Á¶Á÷°Ë»çºÎÅÍ ÇØ º¸¸é ¾î¶³±î ÇÕ´Ï´Ù. Heavy infiltrationÀ̶ó°í ÇÑ Á¡ÀÌ Á¶±Ý ¸¶À½¿¡ °É¸®Áö¸¸, °æÇÑ Á¤µµÀÇ È£»ê±¸ ȤÀº plasma cell ħÀ±Àº Ç︮ÄÚ¹ÚÅÍ À§¿°¿¡¼­µµ º¸ÀÌ´Â ¼Ò°ßÀ̴ϱî¿ä.

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[References]

1) È£»ê±¸¼º À§¿° - »óºÎÀ§Àå°ü,Ç︮ÄÚ¹ÚÅÍÇÐȸ 2018³â ±³À°ÀÚ·á (°è¸íÀÇ´ë ÀÌÇöÁ÷)

2) ³ú ½ºÆĸ£°¡´®ÁõÀ¸·Î ÀÎÇÑ È£»ê±¸¼º À§¿° ȯÀÚ¿¡¼­ÀÇ ÇÁ¶óÁöÄäÅÚ Ä¡·á ´ëÇѳ»°úÇÐȸÁö: Á¦ 93 ±Ç Á¦ 5 È£ 2018

3) Prevalence of eosinophilic gastritis, gastroenteritis, and colitis J Pediatr Gastroenterol Nutr. 2016

4) Eosinophilic gastritis: histopathological characterization and quantification of the normal gastric eosinophil content Mod Pathol. 2011

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.