Division of Gastroenterology, Faculty of Medicine, University of Calgary, Alberta, Canada.
Therap Adv Gastroenterol. 2011 Sep;4(5):301-9. doi: 10.1177/1756283X10392443.
Primary eosinophilic gastrointestinal disorders (EGIDs) represent a spectrum of inflammatory gastrointestinal disorders in which eosinophils infiltrate the gut in the absence of known causes for such tissue eosinophilia. EGIDs can be subgrouped as eosinophilic esophagitis (EE), eosinophilic gastroenteritis (EG), and eosinophilic colitis (EC). The least frequent manifestation of EGIDs is EC. EC is a heterogeneous entity with a bimodal age distribution, presenting with either an acute self-limited bloody diarrhea in otherwise healthy infants or as a more chronic relapsing colitis in young adults. The pathophysiology of primary EC appears related to altered hypersensitivity, principally as a food allergy in infants and T lymphocyte-mediated (i.e. non-IgE associated) in young adults. In adults, symptoms include diarrhea, abdominal pain, and weight loss. Endoscopic changes are generally modest, featuring edema and patchy granularity. Although standardized criteria are not yet established, the diagnosis of EC depends on histopathology that identifies an excess of eosinophils. Therapeutic approaches are based on case reports and small case series, as prospective randomized controlled trials are lacking. Eosinophilic colitis in infants is a rather benign, frequently food-related entity and dietary elimination of the aggressor often resolves the disorder within days. Adolescent or older patients require more aggressive medical management including: glucocorticoids, anti-histamines, leukotriene receptors antagonists as well as novel approaches employing biologics that target interleukin-5 (IL-5) and IgE. This review article summarizes the current knowledge of EC, its epidemiology, clinical manifestations, diagnosis, and treatment.
原发性嗜酸性粒细胞性胃肠道疾病（EGIDs）代表了一组炎症性胃肠道疾病，其中嗜酸性粒细胞在没有已知的组织嗜酸性粒细胞增多原因的情况下浸润肠道。EGIDs 可分为嗜酸性食管炎（EE）、嗜酸性胃肠炎（EG）和嗜酸性结肠炎（EC）。EGIDs 中最不常见的表现是 EC。EC 是一种具有双峰年龄分布的异质性实体，表现为健康婴儿的急性自限性血性腹泻，或年轻成年人的更慢性复发性结肠炎。原发性 EC 的病理生理学似乎与过敏反应改变有关，主要是婴儿的食物过敏和年轻成年人的 T 淋巴细胞介导（即非 IgE 相关）。在成年人中，症状包括腹泻、腹痛和体重减轻。内镜变化通常较轻，表现为水肿和斑片状颗粒状。尽管尚未建立标准化标准，但 EC 的诊断取决于识别嗜酸性粒细胞过多的组织病理学。治疗方法基于病例报告和小病例系列，因为缺乏前瞻性随机对照试验。婴儿嗜酸性结肠炎是一种相当良性的、常与食物有关的疾病，消除攻击因子通常在数天内即可解决该疾病。青少年或成年患者需要更积极的医疗管理，包括：糖皮质激素、抗组胺药、白三烯受体拮抗剂以及使用针对白细胞介素-5（IL-5）和 IgE 的生物制剂的新方法。本文综述了 EC 的最新知识，包括其流行病学、临床表现、诊断和治疗。
