García-Compeán D, González-González J A, González-Moreno E I, Maldonado-Garza H J
Servicio de Gastroenterología, Departamento de Medicina Interna, Hospital Universitario y Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México.
Servicio de Gastroenterología, Departamento de Medicina Interna, Hospital Universitario y Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México.
Rev Gastroenterol Mex. 2017 Oct-Dec;82(4):328-336. doi: 10.1016/j.rgmx.2017.02.007. Epub 2017 Jul 1.
Eosinophilic esophagitis is a chronic antigen-mediated disease characterized by esophageal symptoms, esophageal eosinophilia, and the absence of response to proton pump inhibitors. It is the most frequent cause of dysphagia and food impaction in adults. Its incidence and prevalence is very high in the developed countries (USA, Europe, Australia), where its connotation is that of an emerging epidemic. While studies have been published with large case series in the developed countries, those published in Latin America are small or consist of isolated case reports. The differences in the prevalence of the disease between the developed and developing regions are unknown. Genetic or racial causes have been cited. Nevertheless, the epidemic nature of the disease suggests that environmental causes are the most powerful. Based on the published hypotheses, as well as on epidemiologic studies, the present review discusses some of the possible causes of the disparity in the prevalence of eosinophilic esophagitis between the two types of countries. The 'hygiene hypothesis' is reviewed, together with the possible relation of Helicobacter pylori, intestinal parasites, and modifications of the esophageal microbiota in patients with eosinophilic esophagitis. In reference to studies conducted in the United States, the clinical behavior and progression of eosinophilic esophagitis in Hispanics is reviewed and a possible predominant phenotype in Mexican and other Latin American patients is discussed. Finally, based on the above, an algorithm for studying the disease in the Latin American countries is proposed.
嗜酸性粒细胞性食管炎是一种慢性抗原介导的疾病，其特征为食管症状、食管嗜酸性粒细胞增多以及对质子泵抑制剂无反应。它是成人吞咽困难和食物嵌塞最常见的原因。在发达国家（美国、欧洲、澳大利亚），其发病率和患病率非常高，在这些地区它呈现出一种新出现的流行病的特征。虽然发达国家已发表了大量病例系列研究，但拉丁美洲发表的研究规模较小或仅为个别病例报告。发达地区和发展中地区该疾病患病率的差异尚不清楚。有人提出了遗传或种族原因。然而，该疾病的流行特征表明环境因素是最主要的。基于已发表的假说以及流行病学研究，本综述讨论了两类国家之间嗜酸性粒细胞性食管炎患病率存在差异的一些可能原因。对“卫生假说”进行了综述，同时探讨了幽门螺杆菌、肠道寄生虫以及嗜酸性粒细胞性食管炎患者食管微生物群改变之间的可能关系。参考美国进行的研究，对西班牙裔人群中嗜酸性粒细胞性食管炎的临床行为和病程进行了综述，并讨论了墨西哥和其他拉丁美洲患者可能的主要表型。最后，基于上述内容，提出了在拉丁美洲国家研究该疾病的一种方法。
