Eluri Swathi, Runge Thomas M, Hansen Jason, Kochar Bharati, Reed Craig C, Robey Benjamin S, Woosley John T, Shaheen Nicholas J, Dellon Evan S
Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Department of Pathology and Laboratory Medicine; University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Clin Transl Gastroenterol. 2017 Jun 15;8(6):e97. doi: 10.1038/ctg.2017.27.
While topical corticosteroids are first-line therapy for eosinophilic esophagitis (EoE), the data regarding long-term effectiveness are lacking. We aimed to determine long-term histologic and endoscopic outcomes of maintenance therapy in EoE steroid responders.
We performed a retrospective study of adults with EoE at UNC Hospitals who had initial histologic response (<15 eos/hpf) after 8 weeks of topical steroids, and maintained on therapy. Endoscopic and the histologic data were recorded at baseline and follow-up endoscopies. Multivariable logistic regression was performed to assess loss of treatment response by steroid dose at recurrence, and Kaplan-Meier analysis to calculate durability of disease remission.
Of 55 EoE patients with initial response to swallowed/topical fluticasone or budesonide over a median 11.7 months, 33 had at least two follow-up EGDs. Of these patients, 61% had histologic loss of response and worse endoscopic findings. There was no difference in baseline steroid dose (P=0.55) between the groups, but those maintained on their initial dose had lower odds (OR: 0.10; 95% CI: 0.01, 0.90) of loss of response compared to those who had subsequent dose reduction. On survival analysis, 50% had loss of response to steroids by 18.5 months and 75% by 29.6 months.
In adult EoE steroid responders, loss of treatment response is common, and is associated with a steroid dose reduction. Routinely lowering doses for maintenance steroids may provide inferior outcomes.
虽然局部用皮质类固醇是嗜酸性粒细胞性食管炎（EoE）的一线治疗方法，但缺乏关于其长期有效性的数据。我们旨在确定EoE类固醇反应者维持治疗的长期组织学和内镜检查结果。
我们对北卡罗来纳大学医院的成年EoE患者进行了一项回顾性研究，这些患者在局部使用类固醇8周后出现初始组织学反应（<15个嗜酸性粒细胞/高倍视野），并继续接受治疗。在基线和随访内镜检查时记录内镜和组织学数据。进行多变量逻辑回归以评估复发时类固醇剂量导致的治疗反应丧失情况，并进行Kaplan-Meier分析以计算疾病缓解的持续时间。
55例对吞咽/局部用氟替卡松或布地奈德有初始反应的EoE患者，中位治疗时间为11.7个月，其中33例至少进行了两次随访上消化道内镜检查。在这些患者中，61%出现了组织学反应丧失和更差的内镜检查结果。两组之间的基线类固醇剂量无差异（P = 0.55），但与随后降低剂量的患者相比，维持初始剂量的患者反应丧失的几率较低（OR：0.10；95% CI：0.01，0.90）。生存分析显示，50%的患者在18.5个月时对类固醇失去反应，75%的患者在29.6个月时失去反应。
在成年EoE类固醇反应者中，治疗反应丧失很常见，且与类固醇剂量降低有关。常规降低维持类固醇剂量可能会导致较差的结果。
