Basophil infiltration in eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia
Basophil infiltration in eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia
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DOI：
10.1111/apt.13141
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发表时间：
2015-04-01
影响因子：
7.6
通讯作者：
Arakawa, T.
中科院分区：
文献类型：
--
作者：
Iwakura, N.;Fujiwara, Y.;Arakawa, T.
背景质子泵抑制剂反应性食管嗜酸性粒细胞增多症（PPI-REE）的特征与嗜酸性粒细胞性食管炎（EoE）相似，但PPI-REE表现出对PPI治疗的症状和组织学反应。多项研究表明，嗜碱性粒细胞在过敏性疾病的发病机制中发挥着至关重要的作用。目的识别并比较 EoE、PPI-REE、胃食管反流病（GERD）和正常食管（对照）患者食管上皮中嗜碱性粒细胞的浸润情况。方法对 43 例患者进行活检标本，其中 12 例为 EoE，11 例为 PPI-REE，10 例为 GERD，对 10 个正常食管进行了分析。进行免疫组织化学来量化食管上皮中嗜碱性粒细胞和肥大细胞的数量。对胸腺基质淋巴细胞生成素（TSLP）和嗜碱性粒细胞进行双重免疫荧光染色。 EoE患者接受吞服氟替卡松治疗。结果EoE与PPI-REE患者的临床、内镜或组织学特征无差异。 EoE 和 PPI-REE 患者的嗜碱性粒细胞和肥大细胞多于 GERD 患者和对照受试者。 EoE患者食管上皮嗜碱性粒细胞浸润高于PPI-REE患者（分别为3.62.8/高倍视野 vs. 1.2 +/- 0.9/高倍视野；P=0.02）；然而，两组之间的肥大细胞浸润没有显着差异。 TSLP 在嗜碱性粒细胞浸润区域的食管上皮中高表达。类固醇治疗使EoE患者上皮内嗜碱性粒细胞显着减少。结论嗜酸性粒细胞可能在嗜酸粒细胞性食管炎的发病机制中发挥重要作用。
BackgroundThe features of proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE) are similar to those of eosinophilic oesophagitis (EoE), but PPI-REE demonstrates symptomatic and histological responses to PPI therapy. Several studies have shown that basophils play a crucial role in the pathogenesis of allergic diseases.AimTo identify and compare basophil infiltration in the oesophageal epithelium in patients with EoE, PPI-REE, gastroesophageal reflux disease (GERD) and normal oesophagus (controls).MethodsBiopsy specimens from 43 patients, including 12 with EoE, 11 with PPI-REE, 10 with GERD and 10 normal oesophagus, were analysed. Immunohistochemistry was performed to quantify the number of basophils and mast cells in the oesophageal epithelium. Double immunofluorescence staining for thymic stromal lymphopoietin (TSLP) and basophils was performed. Patients with EoE were treated with swallowed fluticasone.ResultsThere were no differences in clinical, endoscopic or histological features between patients with EoE and PPI-REE. There were more basophils and mast cells in patients with EoE and PPI-REE than in patients with GERD and control subjects. Basophil infiltration of the oesophageal epithelium in patients with EoE was higher than that in patients with PPI-REE (3.62.8 per high power field vs. 1.2 +/- 0.9 per high power field respectively; P=0.02); however, there was no significant difference in mast cell infiltration between the two groups. TSLP was highly expressed in the oesophageal epithelium in areas infiltrated by basophils. Steroid therapy significantly decreased intraepithelial basophils in patients with EoE.ConclusionBasophils may play an important role in the pathogenesis of eosinophilic oesophagitis.