EOSINOPHILIC ESOPHAGITIS ATTRIBUTED TO GASTROESOPHAGEAL REFLUX - IMPROVEMENT WITH AN AMINO ACID-BASED FORMULA
EOSINOPHILIC ESOPHAGITIS ATTRIBUTED TO GASTROESOPHAGEAL REFLUX - IMPROVEMENT WITH AN AMINO ACID-BASED FORMULA
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DOI：
10.1016/0016-5085(95)90637-1
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发表时间：
1995-11-01
期刊：
影响因子：
29.4
通讯作者：
SAMPSON, HA
中科院分区：
文献类型：
--
作者：
KELLY, KJ;LAZENBY, AJ;SAMPSON, HA
背景与目的：食管嗜酸性粒细胞浸润患者的胃食管反流治疗可能无效。本研究的目的是调查是否胃食管反流和食管活检异常的持续症状可能与某些食物的摄入。研究方法：10名先前通过标准测试诊断为胃食管反流的儿童，尽管有标准抗反流治疗，包括6名患者的Nissen胃底折叠术，但仍有长期症状（中位数，34.3个月;范围，6-78个月），给他们喂食基本配方Neocate或Neocate-1-Plus（Scientific Hospital Supplies Inc.，盖瑟斯堡，MD）至少6周。每个孩子都重复内窥镜检查，然后进行开放式食物挑战。结果：在接受配方时，患者症状消退（n = 8）或改善（n = 2）。在随访食管活检中，最大上皮内嗜酸性粒细胞计数在配方试验前（中位数，41;范围，15-100）至后（中位数，0.5;范围，0-22）显著降低（P = 0.005）。食管粘膜的其他反应性上皮改变也显著改善。所有患者在开放式食物挑战中重新出现了先前的症状。结论：慢性胃肠道症状和组织学变化的食管胃食管反流的标准治疗无反应，改善了使用元素的公式。当在开放食物挑战期间重新引入特定膳食蛋白质时，症状复发。这些观察结果的机制尚不清楚。
Background & Aims: Treatment for gastroesophageal reflux may be ineffective in patients with an eosinophilic infiltration of the esophagus. The aim of this study was to investigate whether unremitting symptoms of gastroesophageal reflux and biopsy abnormalities of the esophagus may be associated with the ingestion of certain foods. Methods: Ten children previously diagnosed with gastroesophageal reflux by standard testing with long-standing symptoms (median, 34.3 months; range, 6-78 months) despite standard antireflux therapies, including Nissen fundoplication in 6 patients, were fed the elemental formulas Neocate or Neocate-1-Plus (Scientific Hospital Supplies Inc., Gaithersburg, MD) for a minimum of 6 weeks. Each child had repeat endoscopy followed by open food challenges. Results: While receiving the formulas, patients had either resolution (n = 8) or improvement (n = 2) of symptoms. On follow-up esophageal biopsy, the maximal intraepithelial eosinophil counts decreased significantly before (median, 41; range, 15-100) to after (median, 0.5; range, 0-22) the formula trial (P = 0.005). Other reactive epithelial changes of the esophageal mucosa also improved significantly. All patients redeveloped their previous symptoms on open food challenges. Conclusions: Chronic gastrointestinal symptoms and histological changes of the esophagus unresponsive to standard treatments for gastroesophageal reflux were improved by the use of elemental formulas. Symptoms recurred when specific dietary proteins were reintroduced during open food challenges. The mechanism of these observations is unknown.