Molina-Infante Javier, Gonzalez-Cordero Pedro L, Lucendo Alfredo J
aDepartment of Gastroenterology, Hospital Universitario San Pedro de Alcantara, Caceres bCentro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas (CIBEREHD), Madrid cDepartment of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.
Curr Opin Gastroenterol. 2017 Jul;33(4):285-292. doi: 10.1097/MOG.0000000000000371.
To update rapidly evolving concepts regarding the controversial entity of 'proton pump inhibitor (PPI)-responsive esophageal eosinophilia,' referring to patients with clinical, endoscopic and histologic features of eosinophilic esophagitis (EoE) who achieve remission on PPI therapy.
Up to half of pediatric and adult patients with typical EoE symptoms and histology achieve clinico-pathologic remission on PPI therapy, irrespective of whether esophageal pH monitoring demonstrates abnormal acid reflux. In patients with clinical and histologic features of EoE, genotypic and phenotypic features of PPI responders and nonresponders are virtually indistinguishable, and different from those of patients with gastroesophageal reflux disease. In PPI responders, PPIs effects on esophageal Th2 inflammation and gene expression are similar to those of topical steroids in PPI nonresponders. These therapies, along with diets, recently have been shown to be potentially interchangeable in two small series.
Proton pump inhibitor-responsive esophageal eosinophilia is an inappropriate disease descriptor, arbitrarily based on a response to a single drug, and should be abandoned. Patients who have esophageal eosinophilia and esophageal symptoms that resolve with PPI therapy have phenotypic, molecular, mechanistic, and therapeutic features indistinguishable from similar patients who do not respond to PPIs. These patients with PPI responsiveness should be considered within the spectrum of EoE.
更新关于“质子泵抑制剂（PPI）反应性食管嗜酸性粒细胞增多症”这一有争议实体的快速演变概念，该术语指的是具有嗜酸性食管炎（EoE）临床、内镜和组织学特征且在PPI治疗后病情缓解的患者。
高达一半有典型EoE症状和组织学表现的儿童及成人患者在PPI治疗后实现临床病理缓解，无论食管pH监测是否显示有异常酸反流。在具有EoE临床和组织学特征的患者中，PPI反应者和无反应者的基因型和表型特征几乎无法区分，且与胃食管反流病患者不同。在PPI反应者中，PPI对食管Th2炎症和基因表达的影响与PPI无反应者中局部使用类固醇的影响相似。在两个小系列研究中，这些疗法以及饮食最近已被证明可能具有可互换性。
质子泵抑制剂反应性食管嗜酸性粒细胞增多症是一个不恰当的疾病描述词，它任意地基于对单一药物的反应，应该被摒弃。食管嗜酸性粒细胞增多且食管症状在PPI治疗后缓解的患者，其表型、分子、机制和治疗特征与对PPI无反应的类似患者无法区分。这些对PPI有反应的患者应被纳入EoE的范畴内考虑。
