Northern Adelaide Local Health Network (NALHN), Department of Gastroenterology Lyell McEwin and Modbury Hospitals, University of Adelaide, Adelaide, SA, Australia.
Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, CB#7080, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA.
J Gastroenterol. 2018 Feb;53(2):165-171. doi: 10.1007/s00535-017-1397-z. Epub 2017 Oct 10.
In patients with eosinophilic esophagitis (EoE) who do not respond to proton pump inhibitors, initial anti-inflammatory/anti-eosinophilic treatment is with either topical corticosteroids or dietary elimination. A large body of literature supports the efficacy of these approaches, with histologic response rates in the 50-90% range for steroids and 70% range for the six-food elimination diet. However, these studies are almost all short-term and data evaluating long-term safety and efficacy of either treatment are limited. Nevertheless, because EoE is chronic, symptomatic, endoscopic, and histologic disease activity recurs when successful treatments are stopped. An emerging body of data also suggest that left untreated, persistent eosinophilic esophageal inflammation may progress to fibrostenosis over time. Therefore, maintenance therapy in EoE is intuitively attractive. This paper reviews the rationale for maintenance treatment in EoE, the available long-term pharmacologic and dietary response data for EoE, and discusses who may benefit the most from ongoing treatment. While all patients with EoE can be offered maintenance treatment, this option should be strongly recommended in patients with severe disease phenotypes or complications, including malnutrition or failure to thrive, esophageal fibrostenosis, strictures requiring dilation, recurrent food bolus impaction, history of perforation, and symptoms that recur quickly after treatment discontinuation. In all EoE patients, regular follow-up is also advised.
在质子泵抑制剂治疗无效的嗜酸性粒细胞性食管炎 (EoE) 患者中，初始抗炎/抗嗜酸性粒细胞治疗是使用局部皮质类固醇或饮食消除。大量文献支持这些方法的疗效，类固醇的组织学缓解率在 50-90%之间，六食物消除饮食的缓解率在 70%之间。然而，这些研究几乎都是短期的，并且评估两种治疗方法长期安全性和疗效的数据有限。尽管如此，由于 EoE 是慢性的、有症状的、内镜下的，并且成功治疗停止后，疾病活动会再次出现。越来越多的数据也表明，如果不治疗，持续的嗜酸性粒细胞性食管炎症可能会随着时间的推移进展为纤维瘢痕形成。因此，EoE 的维持治疗具有直观的吸引力。本文回顾了 EoE 维持治疗的基本原理、EoE 的长期药物和饮食反应数据，并讨论了哪些患者最有可能从持续治疗中获益。虽然可以为所有 EoE 患者提供维持治疗，但对于严重疾病表型或并发症（包括营养不良或生长不良、食管纤维瘢痕形成、需要扩张的狭窄、食物团块反复嵌塞、穿孔史和治疗停止后迅速复发的症状）的患者，应强烈推荐这种选择。对于所有 EoE 患者，也建议定期随访。
