Eosinophilic esophagitis: A prevalent disease in the United States that affects all age groups
Eosinophilic esophagitis: A prevalent disease in the United States that affects all age groups
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DOI：
10.1053/j.gastro.2008.02.016
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发表时间：
2008-05-01
期刊：
影响因子：
29.4
通讯作者：
Katzka, David A.
中科院分区：
文献类型：
--
作者：
Kapel, Robert C.;Miller, Jocelyne K.;Katzka, David A.
背景和目的：大多数关于嗜酸性粒细胞性食管炎（EE）的报告仅限于单个机构的小系列研究。这项研究描述了更广泛人群中 EE 的特征。方法：使用国家病理学数据库（Caris Diagnostics，Irving，TX）从一组上消化道内窥镜检查中识别 EE 病例。病理学家审查了潜在病例的幻灯片。研究纳入要求平均 (1) 5 个高倍视野中有 20 个或更多嗜酸性粒细胞，或 (2) 2-4 个高倍视野中有 30 个嗜酸性粒细胞。内窥镜医师提供人口统计和临床信息。结果：从 26 个州的 74,162 名患者中发现了 363 例病例。 EE 以男性为主（比值比，3.0；95% 置信区间，2.4-3.8）。年龄从1岁到98岁不等，其中儿童42名，成人321名。成人最常见的内窥镜检查指征是吞咽困难（70.1%）和胃食管反流病（GERD）/胃灼热（27.1%）。儿童最常报告胃食管反流病/胃灼热（38.1%）和腹痛/消化不良（31.0%）。 25.1%的病例黏膜嗜酸性粒细胞峰值计数为20-59，29.2%的病例黏膜嗜酸性粒细胞峰值计数为60-100，45.7%的病例黏膜嗜酸性粒细胞峰值计数超过100。年龄组和性别间峰值计数无差异，但吞咽困难患者计数较高（P < .001）。研究期间 EE 的患病率有所增加 (P < .001)。结论：EE是一种全国性疾病，各年龄组均有发现，其中男性多发。吞咽困难和胃食管反流病症状是内窥镜检查的常见指征。所有年龄段的嗜酸性粒细胞浸润程度均较高，可能与患者的症状有关。我们的系列重点介绍了这种疾病的重要因素，其患病率和/或认识正在不断增加。
Background & Aims: Most reports on eosinophilic esophagitis (EE) are limited to small series from single institutions. This study describes features of EE in a broader population. Methods: A national pathology database (Caris Diagnostics, Irving, TX) was used to identify EE cases from a cohort of upper endoscopies. Slides from potential cases were reviewed by pathologists. Study inclusion required a mean of (1) 20 eosinophils or more in 5 high-power fields, or (2) 30 eosinophils in 2-4 high-power fields. Endoscopists provided demographic and clinical information. Results: There were 363 cases identified from 74,162 patients and 26 states. EE had a male predominance (odds ratio, 3.0; 95% confidence interval, 2.4-3.8). Ages ranged from 1 to 98 years, including 42 children and 321 adults. The most common endoscopy indications in adults were dysphagia (70.1%) and gastroesophageal reflux disease (GERD)/heartburn (27.1%). Children most frequently reported GERD/heartburn (38.1%) and abdominal pain/dyspepsia (31.0%). A total of 25.1% of cases had a peak mucosal eosinophil count of 20-59, 29.2% had a peak mucosal eosinophil count of 60-100, and 45.7% had a peak mucosal eosinophil count of more than 100. There was no difference in the peak counts between age groups or sexes, but patients with dysphagia had higher counts (P < .001). The prevalence of EE increased during the study period (P < .001). Conclusions: EE is a national disease found in all age groups, more frequently in males. Dysphagia and GERD symptoms are common indications for endoscopy. The degree of eosinophilic infiltration is high throughout all ages and may be related to patients' symptoms. Our series highlights important elements of this disease, the prevalence and/or recognition of which is increasing.