在上消化道内镜检查中，临床和内镜特征不能可靠地区分质子泵抑制剂反应性食管嗜酸性粒细胞增多症和嗜酸性食管炎：一项前瞻性队列研究。
Clinical and endoscopic characteristics do not reliably differentiate PPI-responsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study.
机构信息
1] Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA [2] Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
出版信息
Am J Gastroenterol. 2013 Dec;108(12):1854-60. doi: 10.1038/ajg.2013.363. Epub 2013 Oct 22.
OBJECTIVES
Proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is a newly recognized entity that must be differentiated from eosinophilic esophagitis (EoE). Little is known about this condition. We aimed to determine the prevalence of PPI-REE and EoE in patients undergoing upper endoscopy and determine features that distinguish the two groups.
METHODS
This prospective study conducted at the University of North Carolina from 2009 to 2011 enrolled consecutive adult patients undergoing outpatient upper endoscopy. Subjects had esophageal biopsies to quantify the maximum eosinophil count per high-power field (eos/hpf; hpf=0.24 mm(2)). If biopsies revealed ≥15 eos/hpf, subjects were treated with twice daily PPI for 8 weeks and endoscopy was repeated. If ≥15 eos/hpf persisted despite PPI therapy, EoE was diagnosed. If there were <15 eos/hpf, PPI-REE was diagnosed. The proportion of patients in each group was calculated, and patients with EoE and PPI-REE were compared.
RESULTS
Of the 223 subjects enrolled, 173 had dysphagia and 50 did not. Of those with dysphagia, 66 (38%) had ≥15 eos/hpf. After the PPI trial, 40 (23%) were confirmed to have EoE, and 24 (14%) had PPI-REE. Of those without dysphagia, 2 (4%) had ≥15 eos/hpf, and after the PPI trial, 1 (2%) had EoE. Compared with EoE, PPI-REE patients were more likely to be older and male and less likely to have typical endoscopic findings of EoE. However, none of the individual factors was independently predictive of PPI-REE status on multivariable analysis. Similarly, although some endoscopic findings were differentially distributed between PPI-REE and EoE, none were significantly associated with disease status on multivariable analysis.
CONCLUSIONS
Esophageal eosinophilia is common among patients undergoing esophagogastroduodenoscopy for dysphagia. Although EoE was seen in nearly a quarter of patients with dysphagia, PPI-REE was almost as common, and accounted for over one-third of those with ≥15 eos/hpf. No clinical or endoscopic features independently distinguished PPI-REE from EoE before the PPI trial.
目的
质子泵抑制剂反应性食管嗜酸性粒细胞增多症（PPI-REE）是一种新认识的实体，必须与嗜酸性食管炎（EoE）相区别。目前对这种疾病知之甚少。我们旨在确定在接受上消化道内镜检查的患者中 PPI-REE 和 EoE 的患病率，并确定区分这两组的特征。
方法
这项在北卡罗来纳大学进行的前瞻性研究于 2009 年至 2011 年期间纳入了接受门诊上消化道内镜检查的连续成年患者。受试者进行食管活检以量化每高倍镜视野（hpf；hpf=0.24mm²）的最大嗜酸性粒细胞计数（eos/hpf）。如果活检显示≥15 eos/hpf，则给予患者每日两次质子泵抑制剂（PPI）治疗 8 周，并重复内镜检查。如果尽管使用 PPI 治疗仍持续存在≥15 eos/hpf，则诊断为 EoE。如果 eos/hpf<15，则诊断为 PPI-REE。计算每组患者的比例，并比较 EoE 和 PPI-REE 患者。
结果
在纳入的 223 名患者中，173 名有吞咽困难，50 名没有。在有吞咽困难的患者中，66 名（38%）有≥15 eos/hpf。质子泵抑制剂试验后，40 名（23%）被确诊为 EoE，24 名（14%）为 PPI-REE。在没有吞咽困难的患者中，2 名（4%）有≥15 eos/hpf，质子泵抑制剂试验后，1 名（2%）为 EoE。与 EoE 相比，PPI-REE 患者更可能年龄较大且为男性，且不太可能出现 EoE 的典型内镜表现。然而，在多变量分析中，没有任何单个因素可独立预测 PPI-REE 状态。同样，尽管 PPI-REE 和 EoE 之间存在一些内镜表现差异，但在多变量分析中，没有任何内镜表现与疾病状态显著相关。
结论
在因吞咽困难接受上消化道内镜检查的患者中，食管嗜酸性粒细胞增多症很常见。尽管在有吞咽困难的患者中，近四分之一患有 EoE，但 PPI-REE 也很常见，占≥15 eos/hpf 患者的三分之一以上。在质子泵抑制剂试验之前，没有任何临床或内镜特征可独立区分 PPI-REE 与 EoE。
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