Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA.
Allergy. 2012 Oct;67(10):1299-307. doi: 10.1111/j.1398-9995.2012.02881.x. Epub 2012 Aug 23.
Fibrosis of the esophageal lamina propria is a known complication of eosinophilic esophagitis (EoE). To date, therapy with topical corticosteroids has been shown to reverse esophageal fibrosis in some patients; however, there is little evidence to suggest that dietary therapy can also reverse it. Our aim was to examine whether dietary therapy alone can reverse esophageal fibrosis in children with EoE.
We performed a historical cohort study based on children with EoE who had esophageal fibrosis on pretreatment biopsies using trichrome staining. Post-treatment biopsies were analyzed for fibrosis reversal, and results were compared between patients treated with dietary restriction and those that received topical steroids. Clinical characteristics (age, symptoms, duration of symptoms prior to therapy, treatment type, and duration of therapy) were recorded. Histological markers (eosinophil numbers and eosinophilic degranulation in both epithelium and lamina propria, basal zone hyperplasia, and the presence of eosinophilic microabscesses in the epithelium) were examined by reviewing hematoxylin and eosin-stained biopsies and by immunohistochemical staining. These were examined as potential predictors for fibrosis reversal.
Fibrosis resolved following both dietary restriction and topical steroids (3/17 and 5/9 patients respectively, P = 0.078). Post-treatment symptom resolution and decreased intraepithelial eosinophil numbers were found to be the only significant predictors of fibrosis resolution.
Dietary restriction alone, similar to topical steroids, can reverse fibrosis in children with EoE.
固有层食管纤维化是嗜酸性食管炎（EoE）的已知并发症。迄今为止，局部皮质类固醇治疗已被证明可使一些患者的食管纤维化逆转；然而，几乎没有证据表明饮食疗法也可以逆转它。我们的目的是研究饮食疗法是否可以单独逆转 EoE 儿童的食管纤维化。
我们进行了一项基于在三原色染色预处理活检中存在食管纤维化的 EoE 儿童的历史队列研究。对治疗后的活检进行纤维化逆转分析，并比较接受饮食限制和接受局部类固醇治疗的患者的结果。记录了临床特征（年龄、症状、治疗前症状持续时间、治疗类型和治疗持续时间）。通过检查苏木精和伊红染色的活检和免疫组织化学染色，检查了组织学标志物（上皮和固有层中的嗜酸性粒细胞数量和嗜酸性粒细胞脱颗粒、基底带增生以及上皮中嗜酸性微脓肿的存在）。这些被作为纤维化逆转的潜在预测因子进行了检查。
饮食限制和局部类固醇治疗后纤维化均得到缓解（分别为 3/17 和 5/9 例患者，P=0.078）。治疗后症状缓解和上皮内嗜酸性粒细胞数量减少是纤维化缓解的唯一显著预测因子。
与局部类固醇治疗类似，饮食限制单独治疗可逆转 EoE 儿童的纤维化。
