Clinical implications and pathogenesis of esophageal remodeling in eosinophilic esophagitis.
Clinical implications and pathogenesis of esophageal remodeling in eosinophilic esophagitis.
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DOI：
10.1016/j.gtc.2014.02.015
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发表时间：
2014-06
影响因子：
3.7
通讯作者：
Aceves SS
中科院分区：
文献类型：
--
作者：
Hirano I;Aceves SS
在嗜酸性粒细胞性食管炎（EoE）中，组织学上的重塑改变在上皮和上皮下都很明显，在上皮下固有层（LP）纤维化、固有肌层扩张和血管增加发生。EoE的主要临床症状和并发症在很大程度上是食管重塑的结果。该过程的重要介质包括IL-5、IL-13、tgf - β1、肥大细胞、成纤维细胞和嗜酸性粒细胞。检测重塑效果的方法包括上内镜、组织病理学、食管钡剂造影、超声内镜、食管测压和功能腔内显像。这些形态提供了器官功能障碍的证据，包括局灶性和弥漫性食管狭窄、粘膜和上皮下扩张、食管运动异常和食管扩张性降低。食物嵌塞和食管壁穿孔的并发症与食管口径减小和食管壁硬度增加有关。局部皮质类固醇和消除饮食疗法在解决食管粘膜嗜酸性粒细胞炎症方面的治疗效益是显而易见的。然而，现有的治疗方法已经证明了逆转现有食道重塑变化的不同能力。包括新型靶向生物制剂在内的全身治疗具有解决上皮下重塑的潜力。食管扩张仍然是一种有用的辅助治疗手法，有症状的成人食管狭窄。随着新的治疗方法的出现，治疗终点对食管重塑对整体疾病活动的基本贡献至关重要。
In eosinophilic esophagitis (EoE), remodeling changes are manifest histologically in both the epithelium as well as in the subepithelium where lamina propria (LP) fibrosis, expansion of the muscularis propria and increased vascularity occur. The major clinical symptoms and complications of EoE are largely consequences of esophageal remodeling. Important mediators of the process include IL-5, IL-13, TGFβ1, mast cells, fibroblasts and eosinophils. Methods to detect remodeling effects include upper endoscopy, histopathology, barium esophagram, endoscopic ultrasonography, esophageal manometry, and functional luminal imaging. These modalities provide evidence of organ dysfunction that include focal and diffuse esophageal strictures, expansion of the mucosa and subepithelium, esophageal motor abnormalities and reduced esophageal distensibility. Complications of food impaction and perforations of the esophageal wall have been associated with reduction in esophageal caliber and increased esophageal mural stiffness. The therapeutic benefits of topical corticosteroids and elimination diet therapy in resolving mucosal eosinophilic inflammation of the esophagus are evident. Available therapies, however, have demonstrated variable ability to reverse existing remodeling changes of the esophagus. Systemic therapies that include novel, targeted biologic agents have the potential of addressing subepithelial remodeling. Esophageal dilation remains a useful, adjunctive therapeutic maneuver in symptomatic adults with esophageal stricture. As novel treatments emerge, it is essential that therapeutic endpoints account for the fundamental contributions of esophageal remodeling to overall disease activity.
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影响因子：
29.4
作者：
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