Cohen Marta C, Rao Prithviraj, Thomson Mike, Al-Adnani Mudher
Department of Histopathology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
BMJ Open. 2012 Jan 12;2(1):e000493. doi: 10.1136/bmjopen-2011-000493. Print 2012.
Objectives Eosinophilic oesophagitis (EO) shows eosinophilic infiltration of the mucosa and can present with symptoms indistinguishable from gastrooesophageal reflux disease (GORD). The authors describe the clinical, endoscopic and histopathological features of all cases of histological EO presenting during 2007-2008 with a 2-year follow-up. The incidence of paediatric EO and the features of a subgroup with features of both GORD and EO ('overlap' syndrome (OS)) are described. Design Biopsies with an average of 15 eosinophils/high-power field (HPF) were reviewed in the cohort. OS was suggested when there was coexistence of clinical and histological features of EO and GORD (abnormal pH study), which improved with proton pump inhibitors. Setting Tertiary care. Participants All cases with ≥15 eosinophils/HPF entered the study. Primary outcome measures Patients with EO had an average of 15 eosinophils/HPF. Secondary outcome measures Other histological features of EO included microabscesses, dilated intercellular spaces, basal cell hyperplasia, papillary elongation, etc. Results 24 cases of EO were identified, 13 men and 11 women. The incidence of paediatric oesophageal eosinophilia in the region was 9/100 000 children. 11 of the 24 patients (46%) presented with some form of allergy, six with poor feeding/food aversion, five with dysphagia and four with vomiting. After follow-up, 56.5% were confirmed to have EO, 30.5% responded to treatment for GORD and were categorised as OS, 9% developed eosinophilic gastroenteritis and 4% did not have further upper gastrointestinal symptoms. Conclusions Accurate diagnosis of EO, especially the differentiation from GORD, requires appropriate clinicopathological correlation. A significant proportion of patients with eosinophilia in the mucosa also have GORD (OS). These patients improve after treating the underlying GORD. The study was registered as a Service Evaluation with the Trust (number SE74).
目的 嗜酸性粒细胞性食管炎（EO）表现为黏膜嗜酸性粒细胞浸润，其症状可能与胃食管反流病（GORD）难以区分。作者描述了2007年至2008年期间所有组织学确诊的EO病例的临床、内镜及组织病理学特征，并进行了为期2年的随访。描述了儿童EO的发病率以及具有GORD和EO特征的亚组（“重叠”综合征（OS））的特征。设计 对队列中平均每高倍视野（HPF）有15个嗜酸性粒细胞的活检标本进行回顾。当存在EO和GORD的临床及组织学特征（pH研究异常）且使用质子泵抑制剂治疗后病情改善时，提示为OS。地点 三级医疗中心。参与者 所有每HPF≥15个嗜酸性粒细胞的病例纳入研究。主要结局指标 EO患者平均每HPF有15个嗜酸性粒细胞。次要结局指标 EO的其他组织学特征包括微脓肿、细胞间隙增宽、基底细胞增生、乳头延长等。结果 共确诊24例EO病例，其中男性13例，女性11例。该地区儿童食管嗜酸性粒细胞增多症的发病率为9/100 000儿童。24例患者中有11例（46%）表现出某种形式的过敏，6例有喂养困难/食物厌恶，5例有吞咽困难，4例有呕吐。随访后，56.5%被确诊为EO，30.5%对GORD治疗有反应并被归类为OS，9%发展为嗜酸性粒细胞性胃肠炎，4%无进一步的上消化道症状。结论 EO的准确诊断，尤其是与GORD的鉴别，需要适当的临床病理相关性分析。相当一部分黏膜嗜酸性粒细胞增多的患者也患有GORD（OS）。这些患者在治疗潜在的GORD后病情改善。该研究已作为服务评估在信托机构注册（编号SE74）。
