Clinical and endoscopic characteristics do not reliably differentiate PPI-responsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study.
Clinical and endoscopic characteristics do not reliably differentiate PPI-responsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study.
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DOI：
10.1038/ajg.2013.363
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发表时间：
2013-12
期刊：
影响因子：
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通讯作者：
Shaheen NJ
中科院分区：
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作者：
Dellon ES;Speck O;Woodward K;Gebhart JH;Madanick RD;Levinson S;Fritchie KJ;Woosley JT;Shaheen NJ
质子泵抑制反应性食道嗜酸性粒细胞增多症(PPI-REE)是一个新发现的疾病，必须与嗜酸性食管炎(EoE)相鉴别。人们对这种情况知之甚少。我们的目的是确定接受上消化道内窥镜检查的患者中PPI-REE和EoE的患病率，并确定区分这两组的特征。这项前瞻性研究于2009-2011年在北卡罗来纳大学进行，纳入了连续接受门诊上消化道内窥镜检查的成年患者。受试者接受食道活检，以量化每高倍视野的最大嗜酸性粒细胞计数(Eos/HPF；HPF=0.24mm2)。如果活检显示≥15EOS/HPF，受试者每天接受两次PPI治疗，持续8周，并重复内窥镜检查。如果≥15EOS/HPF持续存在，尽管接受了PPI治疗，则诊断为EoE。如果有15个Eos/HPF，则诊断为PPI-REE。计算每组患者的比例，并对EoE和PPI-REE患者进行比较。在登记的223名受试者中，173人有吞咽困难，50人没有。吞咽困难患者中，66例(38%)≥为15eos/hpf。PPI试验后，40例(23%)确诊为EoE，24例(14%)确诊为PPI-REE。在无吞咽困难的患者中，2例(4%)出现≥15Eos/hpf，1例(2%)出现EoE。与EoE相比，PPI-REE患者更有可能是年龄较大的男性，而不太可能有典型的EoE的内窥镜表现。然而，在多变量分析中，没有一个个体因素独立地预测PPI-REE状态。类似地，虽然一些内窥镜检查结果在PPI-REE和EoE之间有不同的分布，但在多变量分析中，没有一个与疾病状态显著相关。食道嗜酸性粒细胞增多症在因吞咽困难而接受EGD的患者中很常见。虽然EoE见于近四分之一的吞咽困难患者，但Ppi-REE几乎同样常见，占≥15Eos/hpf患者的三分之一以上。在PPI试验之前，没有临床或内窥镜特征独立区分PPI-REE和EoE。
Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized entity that must be differentiated from eosinophilic esophagitis (EoE). Little is known about this condition. We aimed to determine the prevalence of PPI-REE and EoE in patients undergoing upper endoscopy, and determine features that distinguish the two groups. This prospective study conducted at University of North Carolina from 2009–2011 enrolled consecutive adult patients undergoing outpatient upper endoscopy. Subjects had esophageal biopsies to quantify the maximum eosinophil count per high-powered field (eos/hpf; hpf = 0.24mm2). If biopsies revealed ≥15 eos/hpf, subjects were treated with twice daily PPI for 8 weeks and endoscopy was repeated. If ≥15 eos/hpf persisted despite PPI therapy, EoE was diagnosed. If there were <15 eos/hpf, PPI-REE was diagnosed. The proportion of patients in each group was calculated, and patients with EoE and PPI-REE were compared. Of the 223 subjects enrolled, 173 had dysphagia and 50 did not. Of those with dysphagia, 66 (38%) had ≥15 eos/hpf. After the PPI trial, 40 (23%) were confirmed to have EoE, and 24 (14%) had PPI-REE. Of those without dysphagia, 2 (4%) had ≥15 eos/hpf and after the PPI trial, 1 (2%) had EoE. Compared with EoE, PPI-REE patients were more likely to be older and male, and less likely to have typical endoscopic findings of EoE. However, none of the individual factors was independently predictive of PPI-REE status on multivariable analysis. Similarly, while some endoscopic findings were differentially distributed between PPI-REE and EoE, none were significantly associated with disease status on multivariable analysis. Esophageal eosinophilia is common among patients undergoing EGD for dysphagia. While EoE was seen in nearly a quarter of patients with dysphagia, PPI-REE was almost as common, and accounted for over one-third of those with ≥15 eos/hpf. No clinical or endoscopic features independently distinguished PPI-REE from EoE prior to the PPI trial.