Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
J Allergy Clin Immunol. 2010 Jul;126(1):112-9. doi: 10.1016/j.jaci.2010.05.027.
Eosinophilic esophagitis (EE) is now a commonly encountered disorder that was rarely diagnosed a decade ago.
We aimed to determine the epidemiologic and histologic features of retrospective pediatric esophageal eosinophilia before the first case of EE at our institution was recognized.
Esophageal biopsy specimens obtained between 1982 and 1999 with reflux esophagitis were re-examined and reorganized into 2 groups based on peak esophageal eosinophil number (<15 eosinophils per high-powered field [hpf] and > or =15 eosinophils/hpf). The epidemiology and histology of the entire cohort and a population-based cohort were evaluated.
Eight hundred seven biopsy specimens from 666 patients were re-examined; 198 patients had 15 eosinophils/hpf or greater. Among a population-based cohort of patients with 15 eosinophils/hpf or greater, there was a modest increase in incidence (P < .001; incidence rate ratio, 1.18; 95% CI, 1.09-1.28). After correcting for a 40-fold increase in the number of endoscopies during this time period, the proportion of biopsy specimens with 15 eosinophils/hpf or greater did not change (0.08 in 1982 vs 0.08 in 1996 [peak]; P = .9; incidence rate ratio, 1.02; 95% CI, 0.73-1.44). Patients who had as few as 5 eosinophils/hpf were more likely to have persistent esophageal eosinophilia on repeat esophagogastroduodenoscopy, evidence of basal layer hyperplasia, and lamina propria fibrosis compared with patients with less than 5 eosinophils/hpf (P < .001).
Esophageal eosinophilia at levels consistent with EE was present among 30% of patients given diagnoses of reflux esophagitis, and the incidence of esophageal eosinophilia did not change over time. Patients with 5 eosinophils/hpf or greater had evidence of other histologic abnormalities and were likely to have persistent esophageal eosinophilia.
嗜酸性食管炎（EE）是一种目前常见的疾病，而在十年前很少被诊断出来。
我们旨在确定在本机构首例 EE 病例之前，回顾性儿科食管嗜酸性粒细胞增多症的流行病学和组织学特征。
对 1982 年至 1999 年间因反流性食管炎而获得的食管活检标本进行重新检查，并根据食管嗜酸性粒细胞峰值数量（<15 个高倍视野/每高倍视野[hpf]和≥15 个/hpf）将其重新分组。评估了整个队列和基于人群的队列的流行病学和组织学。
对 666 名患者的 807 个活检标本进行了重新检查；198 名患者的嗜酸性粒细胞数量≥15 个/hpf。在嗜酸性粒细胞数量≥15 个/hpf 的基于人群的队列中，发病率略有增加（P<.001；发病率比，1.18；95%置信区间，1.09-1.28）。在校正这段时间内内镜检查数量增加了 40 倍后，嗜酸性粒细胞数量≥15 个/hpf 的活检标本比例没有变化（1982 年为 0.08，1996 年为峰值 0.08[P=.9；发病率比，1.02；95%置信区间，0.73-1.44]）。与嗜酸性粒细胞数量<5 个/hpf 的患者相比，嗜酸性粒细胞数量≥5 个/hpf 的患者在重复食管胃十二指肠镜检查时更有可能持续存在食管嗜酸性粒细胞增多、基底细胞增生和固有层纤维化（P<.001）。
在被诊断为反流性食管炎的患者中，有 30%存在与 EE 一致的食管嗜酸性粒细胞增多症，且食管嗜酸性粒细胞增多症的发病率并未随时间而改变。嗜酸性粒细胞数量≥5 个/hpf 的患者存在其他组织学异常的证据，并且很可能持续存在食管嗜酸性粒细胞增多症。
