Gutiérrez-Junquera Carolina, Fernández-Fernández Sonia, Cilleruelo M Luz, Rayo Ana, Echeverría Luis, Quevedo Sergio, Bracamonte Teresa, Román Enriqueta
*Pediatric Gastroenterology Unit, Department of Pediatrics, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda †Pediatric Gastroenterology Unit ‡Pediatric Allergy Unit, Department of Pediatric, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
J Pediatr Gastroenterol Nutr. 2016 May;62(5):704-10. doi: 10.1097/MPG.0000000000001019.
Proton-pump inhibitor-responsive esophageal eosinophilia is a newly recognized entity with an unclear prevalence in children, as only retrospective data are available. The aim of this study was to determine the prevalence and clinical features of proton-pump inhibitor-responsive esophageal eosinophilia in children.
This prospective study enrolled patients with esophageal symptoms and esophageal eosinophilic counts as 15 or more than 15 eos/hpf (eosinophils per high-power field). Children received treatment with esomeprazole 1 mg · kg per dose twice daily for 8 weeks and the endoscopy was repeated. Complete response to proton-pump inhibitor (PPI) was defined as 5 or less than 5 eos/hpf, and a partial response as >5 and <15 eos/hpf in post-treatment biopsies.
Fifty-one children (74.5% boys) were included. Histological response was observed in 35 children (68.6%): 24 children (47%) had a complete response and 11 children (21.6%) had a partial response. Only 16 children (31.4%) were diagnosed with eosinophilic esophagitis (EoE). There were no differences in history of atopy, allergy tests, pH study results, and endoscopic scores. Clinical symptoms were similar, with the exception of food impaction, which was more frequent in children with EoE (56.2% vs 20%, P = 0.01). The mean pretreatment peak eosinophil count was higher in patients with EoE (74.8 ± 36.2 vs 46.3 ± 30.7, P = 0.007). Eleven of the 14 patients (78.6%) on a lower PPI treatment maintenance dose remained in clinicopathologic remission at 1-year follow-up.
A significant proportion of children with esophageal eosinophilia responded to high dose PPI treatment. Clinical, endoscopic, and pH study results were similar, with exception of patients with EoE, who were more likely to experience food impaction and have higher esophageal eosinophil counts.
质子泵抑制剂反应性食管嗜酸性粒细胞增多症是一种新认识的疾病，在儿童中的患病率尚不清楚，因为仅有回顾性数据。本研究的目的是确定儿童质子泵抑制剂反应性食管嗜酸性粒细胞增多症的患病率和临床特征。
这项前瞻性研究纳入有食管症状且食管嗜酸性粒细胞计数为每高倍视野15个或超过15个嗜酸性粒细胞的患者。儿童接受埃索美拉唑治疗，剂量为1mg·kg，每日两次，共8周，之后重复进行内镜检查。质子泵抑制剂（PPI）完全反应定义为治疗后活检中每高倍视野嗜酸性粒细胞为5个或少于5个，部分反应定义为每高倍视野嗜酸性粒细胞>5个且<15个。
纳入51名儿童（74.5%为男孩）。35名儿童（68.6%）观察到组织学反应：24名儿童（47%）完全反应，11名儿童（21.6%）部分反应。仅16名儿童（31.4%）被诊断为嗜酸性粒细胞性食管炎（EoE）。特应性病史、过敏试验、pH研究结果和内镜评分无差异。临床症状相似，但食物嵌塞在EoE患儿中更常见（56.2%对20%，P = 0.01）。EoE患者治疗前嗜酸性粒细胞峰值计数平均值更高（74.8±36.2对46.3±30.7，P = 0.007）。14名接受较低PPI维持治疗剂量的患者中有11名（78.6%）在1年随访时保持临床病理缓解。
相当一部分食管嗜酸性粒细胞增多症儿童对高剂量PPI治疗有反应除EoE患者外临床、内镜和pH研究结果相似，EoE患者更易发生食物嵌塞且食管嗜酸性粒细胞计数更高。
