Eosinophilic oesophagitis: a novel treatment using Montelukast
Eosinophilic oesophagitis: a novel treatment using Montelukast
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DOI：
10.1136/gut.52.2.181
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发表时间：
2003-02-01
期刊：
影响因子：
24.5
通讯作者：
Whittam, J
中科院分区：
文献类型：
--
作者：
Attwood, SEA;Lewis, CJ;Whittam, J
背景：嗜酸性食管炎是一种罕见的疾病，可见嗜酸粒细胞渗入食道粘膜，并出现明显的吞咽困难症状。未能诊断这种疾病与不愿对明显正常的食道进行活组织检查有关。这对于组织学诊断是必不可少的。到目前为止，只有使用皮质类固醇才能取得治疗成功。我们在这里描述了使用嗜酸性粒细胞稳定剂孟鲁司特来缓解这些患者的症状。患者和方法：自1995年以来，我们的病房中有12名患者在彻底调查了他们的吞咽困难后被确认为这种情况。我们开始对其中8名患者使用白三烯受体拮抗剂孟鲁司特，以改善他们的吞咽症状，同时避免使用长期的皮质类固醇。结果：许多患者以前被误诊，因此在转诊到我科之前进行了长时间的不适当和不成功的治疗。所有患者对单独的抑酸治疗都没有反应，但对孟鲁司特的吞咽表现出改善。8名患者中有6名报告完全主观改善，5名患者在维持治疗方案中完全没有症状。结论：嗜酸性食管炎是一种经常被误诊的疾病，原因是临床医生缺乏认识，不愿对吞咽困难患者的明显正常食道进行活检，从而获得组织学诊断。对这些患者的调查进一步证明，这种疾病是一种与胃食道反流和嗜酸性肠炎不同的病理状态。孟鲁司特已被发现对这些患者的症状控制有重大帮助，同时避免长期使用皮质类固醇。
Background: Eosinophilic oesophagitis is a rarely diagnosed condition involving eosinophil infiltration of the oesophageal mucosa and creating significant symptoms of dysphagia. Failure to diagnose this disorder relates to reluctance to biopsy an apparently normal oesophagus. This is essential for histological diagnosis. To date, treatment success has been achieved only with corticosteroids. We describe here the use of an eosinophil stabilising agent Montelukast for the symptomatic relief of these patients.Patients and methods: Twelve patients have been identified with this condition in our unit since 1995, after thorough investigation of their dysphagia. We commenced eight of these patients on the leukotriene receptor antagonist Montelukast to symptomatically improve their swallowing while avoiding the use of long term corticosteroids.Results: Many of these patients had been previously misdiagnosed, and therefore inappropriately and unsuccessfully treated for an extensive period prior to referral to our unit. All patients were unresponsive to acid suppression therapy alone but showed improvement in their swallowing on Montelukast. Six of eight reported complete subjective improvement, five patients remaining completely asymptomatic on a maintenance regimen.Conclusions: Eosinophilic oesophagitis is a disease that is often misdiagnosed due to lack of awareness and reluctance of clinicians to biopsy an apparently normal oesophagus in dysphagic patients, and therefore obtain a histological diagnosis. Investigation of these patients adds further evidence to this condition being a separate pathological state from gastro-oesophageal reflux and eosinophilic enteritis. Montelukast has been found to be of significant help in the symptomatic control of these patients while avoiding long term corticosteroids use.