Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis.
Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis.
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DOI：
10.1136/gutjnl-2015-310991
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发表时间：
2016-03
期刊：
影响因子：
24.5
通讯作者：
PPI-REE Task Force of the European Society of Eosinophilic Oesophagitis (EUREOS)
中科院分区：
文献类型：
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作者：
Molina-Infante J;Bredenoord AJ;Cheng E;Dellon ES;Furuta GT;Gupta SK;Hirano I;Katzka DA;Moawad FJ;Rothenberg ME;Schoepfer A;Spechler SJ;Wen T;Straumann A;Lucendo AJ;PPI-REE Task Force of the European Society of Eosinophilic Oesophagitis (EUREOS)
通过对质子泵抑制剂 (PPI) 试验的反应来区分胃食管反流病 (GORD) 和嗜酸性粒细胞性食管炎 (EoE) 的共识诊断建议意外地发现了一种称为“PPI 反应性食管嗜酸性粒细胞增多症”(PPI-REE) 的实体。 PPI-REE 是指具有 EoE 临床和组织学特征但经 PPI 治疗缓解的患者。最近不断发展的证据（主要来自成人）表明，基线时的 PPI-REE 和 EoE 患者在临床、内窥镜和组织学上无法区分，并且在 Th2 免疫介导的炎症和基因表达特征方面具有显着重叠。此外，PPI 治疗可恢复 PPI-REE 患者食管粘膜的完整性、减少 Th2 炎症并逆转异常基因表达特征，类似于 EoE 患者局部类固醇的效果。此外，最近的系列报道称，对饮食/局部类固醇有反应的 EoE 患者也可能通过 PPI 治疗获得缓解。越来越多的证据支持这一概念，即 PPI-REE 代表了 EoE 基础相同免疫机制的连续体。因此，当无法可靠区分 PPI-REE 的表型、分子、机制和治疗特征时，根据对 PPI 治疗的不同反应来区分 PPI-REE 和 EoE 似乎是违反直觉的。对于具有 EoE 症状和组织学特征的患者，不应将 PPI 治疗视为诊断测试，而是将其视为治疗药物。由于其安全性、易于给药和高反应率（高达 50%），PPI 可被视为排在饮食和外用类固醇之前的一线治疗方法。一些 EoE 患者对 PPI 有反应而另一些患者没有反应的原因仍有待阐明。
Consensus diagnostic recommendations to distinguish gastro-oesophageal reflux disease (GORD) from eosinophilic oesophagitis (EoE) by response to a trial of proton pump inhibitors (PPI) unexpectedly uncovered an entity called “PPI-responsive oesophageal eosinophilia” (PPI-REE). PPI-REE refers to patients with clinical and histologic features of EoE that remit with PPI treatment. Recent and evolving evidence, mostly from adults, shows that PPI-REE and EoE patients at baseline are clinically, endoscopically and histologically indistinguishable, and have significant overlap in terms of features of Th2 immune-mediated inflammation and gene expression. Furthermore, PPI therapy restores oesophageal mucosal integrity, reduces Th2 inflammation and reverses the abnormal gene expression signature in PPI-REE patients, similar to the effects of topical steroids in EoE patients. Additionally, recent series have reported that EoE patients responsive to diet/topical steroids may also achieve remission on PPI therapy. This mounting evidence supports the concept that PPI-REE represents a continuum of the same immunologic mechanisms that underlie EoE. Accordingly, it seems counterintuitive to differentiate PPI-REE from EoE based on a differential response to PPI therapy when their phenotypic, molecular, mechanistic, and therapeutic features cannot be reliably distinguished. For patients with symptoms and histologic features of EoE, it is reasonable to consider PPI therapy not as a diagnostic test, but as a therapeutic agent. Due to its safety profile, ease of administration and high response rates (up to 50%), PPI can be considered a first-line treatment, before diet and topical steroids. The reasons why some EoE patients respond to PPI, while others do not, remain to be elucidated.