霉菌性食管炎临床分析

目的探讨霉菌性食管炎的临床表现和诊断,提高对霉菌性食管炎的认识。方法回顾性分析2013年1月至2015年12月北京协和医院胃镜检查诊断的38例霉菌性食管炎患者的临床资料。结果患者平均年龄(54.0±1.5)岁;男性26例,女性12例。29例(76.3%)患者有至少一种危险因素。7例合并口腔念珠菌病。仅10例患者表现出霉菌性食管炎的常见症状。按Kodsi等的内镜下分级,Ⅰ级6例、Ⅱ级29例、Ⅲ级1例、Ⅳ级2例。多数患者接受了系统性抗真菌治疗,但有1例患者未经治疗复查胃镜自愈。结论霉菌性食管炎临床症状不典型,诊断需要依据胃镜检查并组织病理和病原学检查;推荐给予全身性抗真菌治疗,首选氟康唑。然而,对于免疫功能正常、无症状和内镜下病变轻微的患者,是否需要系统性抗真菌治疗还有待进一步研究。

Clinical analysis of fungal esophagitis

Objective To sum up the experience in diagnosis of fungal esophagitis. Methods An analysis was per-formed on clinical data of 38 cases of fungal esophagitis diagnosed through gastroscopy in Peking Union Medical College Hospital from Jan. 2013 to Dec. 2015. Results Of 38 cases, 26 were males and 12 were females. The mean age was(54.0±1.5) years old.76.3% had at least one risk factor.7 patients had oral candidiasis and 10 pa-tients had typical symptom of fungal esophagitis. Endoscopic severity was classified according to Kodsi's grade:gradeⅠ6 cases,grade Ⅱ29 cases, grade Ⅲ 1 case,grade Ⅳ 2 cases. Most patients were treated with systemic antifungal therapy. However,one patient's fungal esophagitis resolved without any treatment. Conclusions Endos-copy with biopsy is a valuable definitive diagnostic method for fungal esophagitis, especially for asymptomatic pa-tients or those without oral candidiasis. Systemic antifungal treatment is recommended with fluconazole as the first choice. More evaluation is needed to determine if systemic antifungal therapy is necessary for asymptomatic and im-munocompetent patients with mild fungal esophagitis.