Spechler Stuart Jon, Genta Robert M, Souza Rhonda F
Department of Medicine, Dallas Department of Veterans Affairs Medical Center, and The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75216, USA.
Am J Gastroenterol. 2007 Jun;102(6):1301-6. doi: 10.1111/j.1572-0241.2007.01179.x.
Recent data suggest that the interaction between gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can be complex, and that the notion of establishing a clear distinction between the two disorders may be too simplistic. There are at least four situations in which GERD might be associated with esophageal eosinophils: (a) GERD causes esophageal injury that results in a mild eosinophilic infiltration, (b) GERD and eosinophilic esophagitis coexist but are unrelated, (c) eosinophilic esophagitis contributes to or causes GERD, or (d) GERD contributes to or causes eosinophilic esophagitis. The high frequency of GERD described in adult patients with eosinophilic esophagitis suggests that there may be more than a chance association between the two disorders. This report discusses potential mechanisms for the complex interaction between GERD and eosinophilic esophagitis. We hope that this information will serve as a conceptual basis for future studies on the relationship between the two disorders. Whereas there are a number of plausible mechanisms whereby GERD might contribute to the accumulation of eosinophils in the esophageal epithelium, it seems prudent to recommend a clinical trial of proton pump inhibitor (PPI) therapy even when the diagnosis of eosinophilic esophagitis seems clear-cut. Furthermore, we suggest that a favorable response to PPI therapy does not preclude a diagnosis of eosinophilic esophagitis.
近期数据表明，胃食管反流病（GERD）与嗜酸性食管炎之间的相互作用可能很复杂，认为在这两种疾病之间建立明确区分的观念可能过于简单化。GERD与食管嗜酸性粒细胞相关的情况至少有四种：（a）GERD导致食管损伤，进而引起轻度嗜酸性粒细胞浸润；（b）GERD与嗜酸性食管炎共存但无关联；（c）嗜酸性食管炎促成或导致GERD；或（d）GERD促成或导致嗜酸性食管炎。在患有嗜酸性食管炎的成年患者中所描述的GERD的高发生率表明，这两种疾病之间可能不仅仅是偶然关联。本报告讨论了GERD与嗜酸性食管炎之间复杂相互作用的潜在机制。我们希望这些信息将作为未来关于这两种疾病关系研究的概念基础。虽然有许多合理的机制表明GERD可能促成食管上皮中嗜酸性粒细胞的积聚，但即使嗜酸性食管炎的诊断似乎很明确，推荐进行质子泵抑制剂（PPI）治疗的临床试验似乎也是谨慎之举。此外，我们认为对PPI治疗的良好反应并不排除嗜酸性食管炎的诊断。
