Distinguishing GERD from eosinophilic oesophagitis: concepts and controversies.
Distinguishing GERD from eosinophilic oesophagitis: concepts and controversies.
复制标题
将GERD与嗜酸性粒细胞性食性炎区分开：概念和争议。
DOI：
10.1038/nrgastro.2015.75
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发表时间：
2015-07
期刊：
影响因子：
--
通讯作者：
Hirano I
中科院分区：
文献类型：
--
作者：
Kia L;Hirano I
在过去的三十年中，食管粘膜嗜酸性粒细胞的检测已经从GERD的生物标志物转变为嗜酸性食管炎（EoE）的诊断标准。在GERD中，食管嗜酸性粒细胞被认为是对酸反流的慢性炎症反应的一部分，而EoE中显著的嗜酸性粒细胞被认为是对摄入食物和/或环境抗原刺激的免疫反应的中心特征。有相当一部分患者出现EoE的症状、内镜和组织学检查结果，经PPI治疗后消退，这导致了EoE与GERD区别的混淆和争议。研究结果表明，PPI反应性食管嗜酸性粒细胞增多症（PPI-REE）从临床和免疫学方面都更接近EoE而不是GERD。尽管PPI治疗的反应性不应用于排除EoE，但PPI治疗可有效降低约40%患者的食管嗜酸性粒细胞增多症，PPI治疗是食管嗜酸性粒细胞增多症患者管理的安全且实用的初始步骤。正在进行的研究阐明PPI-REE背后的机制将提高我们对EoE的理解和管理。在这篇评论中，机制和证据，在GERD和EOE之间的区别的争议进行了评估。
Over the past three decades, the detection of oesophageal mucosal eosinophils has transitioned from a biomarker of GERD to a diagnostic criterion for eosinophilic oesophagitis (EoE). In GERD, oesophageal eosinophils are considered part of the chronic inflammatory response to acid reflux, whereas the marked eosinophilia in EoE is viewed as a central feature of the immune response to ingested food and/or environmental antigen stimulation. Descriptions of a considerable subset of patients with symptomatic, endoscopic and histological findings of EoE that resolve with PPI therapy has led to confusion and controversy regarding the distinction of EoE from GERD. Study findings indicate that PPI-responsive oesophageal eosinophilia (PPI-REE) more closely resembles EoE than GERD, both from a clinical and immunological aspect. Although responsiveness to PPI therapy should not be utilized to exclude EoE, PPI therapy is effective at reducing oesophageal eosinophilia in ~40% of patients, and PPI therapy is both a safe and practical initial step in the management of patients with oesophageal eosinophilia. Ongoing studies elucidating the mechanism behind PPI-REE will improve our understanding and management of EoE. In this Review, the mechanisms and evidence that underlie the controversy in the distinction between GERD and EoE are evaluated.