Cianferoni Antonella, Spergel Jonathan M
Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA, 19104-4399, USA,
Curr Allergy Asthma Rep. 2015 Sep;15(9):58. doi: 10.1007/s11882-015-0558-5.
Eosinophilic gastrointestinal disease (EGID) can be classified as eosinophilic esophagitis (EoE) when the eosinophilia is limited to the esophagus or as eosinophilic gastritis (EG) if it is limited to the gastric tract, eosinophilic colitis (EC) if it is limited to the colon, and eosinophilic gastroenteritis (EGE) if the eosinophilia involves one or more parts of the gastrointestinal tract. EoE is by far the most common EGID. It is a well-defined chronic atopic disease due to a T helper type 2 (Th2) inflammation triggered often by food allergens. EoE diagnosis is done if an esophageal biopsy shows at least 15 eosinophils per high power field (eos/hpf). Globally accepted long-term therapies for EoE are the use of swallowed inhaled steroids or food antigen avoidance. The treatment of EoE is done not only to control symptoms but also to prevent complications such as esophageal stricture and food impaction. EGE cause non-specific gastrointestinal (GI) symptoms and are diagnosed if esophagogastroduodenoscopy (EGD)/colonoscopy show eosinophilia in one or more parts of the GI tract. They are rare diseases with an unclear pathogenesis, and they are poorly defined in terms of diagnostic criteria and treatment. Before initiating treatment of any EGE, it is imperative to conduct a differential diagnosis to exclude other causes of hypereosinophilia with GI localization. EGE are often poorly responsive to therapy and there is no commonly accepted long-term treatment. EG has many characteristics similar to EoE, including the fact that it is often due to a food allergen-driven Th2 inflammation; transcriptome analysis however shows that it is more a systemic disease and has a different gene signature than EoE. EC is a benign form of delayed food allergy in infant and is instead a difficult-to-treat severe inflammatory condition in older children and adults. EC in the latter groups can be a manifestation of drug allergy or autoimmune disease. Overall EGE, EC, and EG are rare and are a diagnosis of exclusion until more common causes of eosinophilia have been excluded.
嗜酸性粒细胞性胃肠道疾病(EGID),若嗜酸性粒细胞增多仅限于食管,则可分类为嗜酸性粒细胞性食管炎(EoE);若仅限于胃肠道,则为嗜酸性粒细胞性胃炎(EG);若仅限于结肠,则为嗜酸性粒细胞性结肠炎(EC);若嗜酸性粒细胞增多累及胃肠道的一个或多个部位,则为嗜酸性粒细胞性胃肠炎(EGE)。EoE是迄今为止最常见的EGID。它是一种明确的慢性特应性疾病,由食物过敏原引发的2型辅助性T(Th2)炎症所致。如果食管活检显示每高倍视野至少有15个嗜酸性粒细胞(eos/hpf),则可诊断为EoE。全球公认的EoE长期治疗方法是使用吞咽吸入性类固醇或避免食物抗原。EoE的治疗不仅是为了控制症状,也是为了预防诸如食管狭窄和食物嵌塞等并发症。EGE会引起非特异性胃肠道(GI)症状,如果食管胃十二指肠镜检查(EGD)/结肠镜检查显示胃肠道的一个或多个部位有嗜酸性粒细胞增多,则可诊断为EGE。它们是罕见疾病,发病机制尚不清楚,在诊断标准和治疗方面定义不明确。在开始任何EGE治疗之前,必须进行鉴别诊断,以排除其他伴有胃肠道定位的嗜酸性粒细胞增多的原因。EGE通常对治疗反应不佳,且没有普遍接受的长期治疗方法。EG有许多与EoE相似的特征,包括它通常由食物过敏原驱动的Th2炎症引起;然而,转录组分析表明,它更像是一种全身性疾病,并且与EoE有不同的基因特征。EC在婴儿中是迟发性食物过敏的一种良性形式,而在大龄儿童和成人中则是一种难以治疗的严重炎症性疾病。后一组中的EC可能是药物过敏或自身免疫性疾病的表现。总体而言,EGE、EC和EG都很罕见,在排除嗜酸性粒细胞增多的更常见原因之前,它们都是排除性诊断。
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