Similarities and differences among eosinophilic esophagitis, proton-pump inhibitor-responsive esophageal eosinophilia, and reflux esophagitis: comparisons of clinical, endoscopic, and histopathological findings in Japanese patients
Similarities and differences among eosinophilic esophagitis, proton-pump inhibitor-responsive esophageal eosinophilia, and reflux esophagitis: comparisons of clinical, endoscopic, and histopathological findings in Japanese patients
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DOI：
10.1007/s00535-016-1213-1
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发表时间：
2017-02-01
影响因子：
6.3
通讯作者：
Kinoshita, Yoshikazu
中科院分区：
文献类型：
--
作者：
Jiao, Dijin;Ishimura, Norihisa;Kinoshita, Yoshikazu
背景 食管嗜酸性粒细胞增多症分为嗜酸性粒细胞性食管炎 (EoE) 或质子泵抑制剂反应性食管嗜酸性粒细胞增多症 (PPI-REE)，具体取决于对 PPI 治疗的反应。本研究的目的是比较日本患者 EoE 和 PPI-REE 的临床、内窥镜和组织病理学结果。此外，将这些病例的特征与反流性食管炎（RE）病例进行比较。方法纳入2005年至2015年在岛根大学医院连续检查的11例EoE患者、16例PPI-REE患者和39例RE患者。回顾性检查和比较各组患者的临床、内镜和组织病理学检查结果。结果 EoE 和 PPI-REE 的临床特征差异不显着，但与 RE 患者相比，EoE 和 PPI-REE 患者年龄较小，过敏合并症发生率更高，并且主诉吞咽困难症状更频繁。 EoE 和 PPI-REE 之间唯一值得注意的差异是 EoE 患者更频繁地报告哮喘（36.4% vs. 2.6%）和食物过敏（27.3% vs. 0%）（分别为 P < 0.05、P < 0.05）。 EoE 和 PPI-REE 患者的内窥镜检查结果相似，唯一的区别是一小部分 PPI-REE 病例存在食管糜烂。 EoE和PPI-REE之间没有组织病理学差异。结论EoE和PPI-REE的临床、内镜和组织病理学结果的比较表明，这两种类型具有相似的特征，尽管EoE患者表现出更高的特应性背景。预测食管嗜酸性粒细胞增多病例的 PPI 反应很困难，需要进一步研究。
Background Esophageal eosinophilia is classified as either eosinophilic esophagitis (EoE) or proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE), depending on the response to PPI treatment. The aim of this study was to compare the clinical, endoscopic, and histopathological findings of EoE and PPI-REE in Japanese patients. In addition, the characteristics of these cases were compared with those of reflux esophagitis (RE) cases.Methods Eleven patients diagnosed with EoE, 16 with PPI-REE, and 39 with RE, who were all consecutively examined from 2005 to 2015 at Shimane University Hospital, were enrolled. Clinical, endoscopic, and histopathological esophageal findings in these groups were retrospectively examined and compared.Results The differences in the clinical characteristics of EoE and PPI-REE were not remarkable, though patients with EoE and PPI-REE were younger, presented a higher prevalence of allergic comorbidities, and complained of symptoms of dysphagia more frequently than those with RE. The only noteworthy differences between EoE and PPI-REE were more frequent reports of asthma (36.4 vs. 2.6 %) and food allergy (27.3 vs. 0 %) by patients with EoE (P < 0.05, P < 0.05, respectively). Endoscopic findings in patients with EoE and PPI-REE were similar, with the presence of esophageal erosions in a small percentage of PPI-REE cases being the only difference. There were no histopathological differences between EoE and PPI-REE.Conclusions Comparisons of clinical, endoscopic, and histopathological findings between EoE and PPI-REE showed that these two types have similar characteristics, though EoE patients showed a higher atopic background. Predicting PPI responsiveness in cases with esophageal eosinophilia is difficult and requires further investigation.