Singla Manish B, Chehade Mirna, Brizuela Diana, Maydonovitch Corinne L, Chen Yen-Ju, Riffle Mary Ellen, Achem Sami R, Moawad Fouad J
Gastroenterology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Department of Pediatrics and Medicine, Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Clin Transl Gastroenterol. 2015 Dec 17;6(12):e132. doi: 10.1038/ctg.2015.62.
Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that causes esophageal remodeling and stricture formation. We compared the clinical course of symptoms, endoscopic findings, histology, and changes in phenotype over time in EoE patients with inflammatory and fibrostenotic phenotypes.
Data were obtained from EoE patients from three medical centers and followed prospectively. Endoscopic features and histology from index and follow-up endoscopies were recorded. Behavior was classified as inflammatory if endoscopic findings demonstrated furrows or white plaques and as fibrostenotic if endoscopic findings included fixed rings or strictures.
Two hundred and fifty-six EoE patients were included in the analysis. The mean age was 32±18 years, 25% of patients were <18 years, 89% of patients were Caucasians, and 74% of patients were male. The mean duration of symptoms before diagnosis was 6.8±7.2 years with a follow-up of 1.7±1.9 years (maximum follow-up of 12 years). Fifty-four percent of patients presented with fibrostenotic EoE, whereas 46% presented with inflammatory EoE. Patients with inflammatory disease were younger than those with fibrostenotic disease (24±19 vs. 39±15 years, P<0.001). Patients with fibrostenotic disease had a longer duration of symptoms than those with inflammatory disease (8.1±7.7 vs. 5.3±6.3 years, P=0.002). Over the study period, 47 (18%) had remission of inflammatory EoE, 68 (27%) continued to have inflammatory disease, 74 (29%) continued to have fibrostenotic disease, 65 (25%) fibrostenotic patients had regression of fibrosis, and 2 patients (1%) progressed from inflammatory disease to fibrostenotic disease. Patients who had regression from their fibrostenosis were more likely than patients who continued to demonstrate fibrostenosis to have a decrease in proximal (54% vs. 32%, P<0.001) and distal (70% vs. 38%, P<0.001) eosinophilia.
Most EoE patients maintained their phenotype or had an improvement with <1% progressing from inflammatory to fibrostenosis. This suggests that early therapeutic strategies aimed at controlling inflammation may interrupt, decrease, or prevent the remodeling fibrosis in EoE.
嗜酸性粒细胞性食管炎（EoE）是一种慢性炎症性疾病，可导致食管重塑和狭窄形成。我们比较了具有炎症性和纤维狭窄性表型的EoE患者的症状临床过程、内镜检查结果、组织学以及表型随时间的变化。
从三个医疗中心的EoE患者中获取数据并进行前瞻性随访。记录初次及随访内镜检查的内镜特征和组织学情况。如果内镜检查结果显示有皱襞或白色斑块，则行为分类为炎症性；如果内镜检查结果包括固定环或狭窄，则分类为纤维狭窄性。
256例EoE患者纳入分析。平均年龄为32±18岁，25%的患者年龄<18岁，89%的患者为白种人，74%的患者为男性。诊断前症状的平均持续时间为6.8±7.2年，随访时间为1.7±1.9年（最长随访12年）。54%的患者表现为纤维狭窄性EoE，而46%的患者表现为炎症性EoE。炎症性疾病患者比纤维狭窄性疾病患者年轻（24±19岁 vs. 39±15岁，P<0.001）。纤维狭窄性疾病患者的症状持续时间比炎症性疾病患者长（8.1±7.7年 vs. 5.3±6.3年，P=0.002）。在研究期间，47例（18%）炎症性EoE患者缓解，68例（27%）持续患有炎症性疾病，74例（29%）持续患有纤维狭窄性疾病，65例（25%）纤维狭窄性患者的纤维化有所消退，2例（1%）患者从炎症性疾病进展为纤维狭窄性疾病。纤维化消退的患者比持续存在纤维狭窄的患者更有可能近端（54% vs. 32%，P<0.001）和远端（70% vs. 38%，P<0.001）嗜酸性粒细胞减少。
大多数EoE患者维持其表型或有所改善，<1%的患者从炎症性进展为纤维狭窄性。这表明旨在控制炎症的早期治疗策略可能会中断、减少或预防EoE中的重塑纤维化。
