Eosinophilic esophagitis: A 10-year experience in 381 children
Eosinophilic esophagitis: A 10-year experience in 381 children
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DOI：
10.1016/s1542-3565(05)00885-2
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发表时间：
2005-12-01
影响因子：
12.6
通讯作者：
Markowitz, JE
中科院分区：
文献类型：
--
作者：
Liacouras, CA;Spergel, JM;Markowitz, JE
背景与目的：嗜酸性食管炎(Eosinophilic EoE，EoE)是一种以严重、孤立的食道嗜酸性粒细胞渗入为特征的疾病，对侵袭性酸阻断无反应，但对饮食中抗原的去除有反应。我们提供与我们10年来诊断为EoE的儿童的经验相关的信息。方法：我们在1994年1月1日至2004年1月1日进行了一项回顾性研究，评估所有被诊断为EoE的患者。收集并评估临床症状、人口学数据、内窥镜检查结果和各种治疗方案的结果。结果：381例EoE患者(男66%，年龄9.1±-3.1岁)中，312例有胃食道反流症状，69例有吞咽困难。内窥镜检查，68%的患者食道外观异常；32%的患者食道外观正常，尽管组织学上有严重的食道嗜酸性粒细胞增多症。食道近端嗜酸性粒细胞数平均为23.3+/-10.5个，远端为38.7+/-13.3个。皮质类固醇显著改善临床症状和食道组织学；然而，在停药后，症状和食道嗜酸性粒细胞增多复发。使用基于氨基酸的配方的饮食限制或完全取消饮食分别显著改善了75名和172名患者的临床症状和食道组织学。结论：皮质类固醇等药物是有效的；然而，停药后EoE复发。去除饮食抗原显著改善了98%的患者的临床症状和食道组织学。
Background & Aims: Eosinophilic esophagitis (EoE) is a disorder characterized by a severe, isolated eosinophilic infiltration of the esophagus unresponsive to aggressive acid blockade but responsive to the removal of dietary antigens. We present information relating to our 10-year experience in children diagnosed with EoE. Methods: We conducted a retrospective study between January 1, 1994, and January 1, 2004, to evaluate all patients diagnosed with EoE. Clinical symptoms, demographic data, endoscopic findings, and the results of various treatment regimens were collected and evaluated. Results: A total of 381 patients (66% male, age 9.1 +/- 3.1 years) were diagnosed with EoE: 312 presented with symptoms of gastroesophageal reflux; 69 presented with dysphagia. Endoscopically, 68% of patients had a visually abnormal esophagus; 32% had a normal-appearing esophagus despite a severe histologic esophageal eosinophilia. The average number of esophageal eosinophils (per 400 x high power field) proximally and distally were 23.3 +/- 10.5 and 38.7 +/- 13.3, respectively. Corticosteroids significantly improved clinical symptoms and esophageal histology; however, upon their withdrawal, the symptoms and esophageal eosinophilia recurred. Dietary restriction or complete dietary elimination using an amino acid-based formula significantly improved both the clinical symptoms and esophageal histology in 75 and 172 patients, respectively. Conclusions: Medications such as corticosteroids are effective; however, upon withdrawal, EoE recurs. The removal of dietary antigens significantly improved clinical symptoms and esophageal histology in 98% of patients.