Dellon Evan S
Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB# 7080, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, North Carolina 27599-7080, USA.
Center for Gastrointestinal Biology and Diseases, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB# 7080, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, North Carolina 27599-7080, USA.
Nat Rev Gastroenterol Hepatol. 2017 Aug;14(8):479-490. doi: 10.1038/nrgastro.2017.56. Epub 2017 May 24.
The goal of this Review is to discuss the clinical approach to patients who do not respond to treatment for eosinophilic oesophagitis (EoE). Refractory EoE is challenging to manage as there are limited data to guide decision-making. In this Review, refractory EoE is defined as persistent eosinophilia in the setting of incomplete resolution of the primary presenting symptoms and incomplete resolution of endoscopic findings following a PPI trial, and after treatment with either topical steroids or dietary elimination. However, this definition is controversial. This Review will examine these controversies, explore how frequently non-response is observed, and highlight potential explanations and predictors of non-response. Non-response is common and affects a large proportion of patients with EoE. It is important to systematically assess multiple possible causes of non-response, as well as consider treatment complications and an incorrect diagnosis of EoE. If non-response is confirmed, second-line treatments are required. Although the overall response rate for second-line therapy is disappointing, with only half of patients eventually responding, there are several promising agents that are currently under investigation, and the future is bright for new treatment modalities for refractory EoE.
本综述的目的是探讨针对嗜酸性粒细胞性食管炎（EoE）治疗无反应患者的临床处理方法。难治性EoE的管理具有挑战性，因为指导决策的数据有限。在本综述中，难治性EoE被定义为在质子泵抑制剂（PPI）试验后，以及在局部使用类固醇或饮食排除治疗后，主要症状未完全缓解且内镜检查结果未完全恢复的情况下持续存在嗜酸性粒细胞增多。然而，这一定义存在争议。本综述将审视这些争议，探究无反应的观察频率，并强调无反应的潜在原因及预测因素。无反应很常见，影响着很大一部分EoE患者。系统评估无反应的多种可能原因，以及考虑治疗并发症和EoE的误诊情况很重要。如果确认无反应，则需要二线治疗。尽管二线治疗的总体有效率令人失望，最终只有一半的患者有反应，但目前有几种有前景的药物正在研究中，难治性EoE新治疗模式的未来前景光明。
