Patel Ronak Vashi, Hirano Ikuo
Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 North Saint Clair, Suite 1400, Chicago, IL, 60611, USA.
Curr Treat Options Gastroenterol. 2018 Mar;16(1):15-26. doi: 10.1007/s11938-018-0167-1.
Eosinophilic esophagitis (EoE) has transformed over the past two decades from a little-known entity to a significant cause of morbidity in the adult and pediatric population. We reviewed the most recent advancements in the diagnosis, therapy, and long-term monitoring of EoE.
Based on clinical, endoscopic, histologic, immunologic, and genetic similarities, there is growing consensus to move away from distinguishing proton pump inhibitor responsive esophageal eosinophilia as an entity distinct from EoE. An increasing number of studies have identified duration of untreated disease as an important determinant of esophageal stricture formation. New approaches to the empiric elimination diet including one, two, four, and step-up protocols were developed to reduce the need for repeated endoscopies during reintroduction of food triggers. Topical steroids remain the mainstay of medical therapy but newer formulations are under development to optimize esophageal delivery. Novel, disease activity monitoring techniques are being evaluated that assess esophageal inflammatory activity without the need for endoscopy. Understanding of EoE has increased remarkably from the first identification of the disease. The underlying pathogenesis continues to be explored leading to shifts in diagnostic criteria as well as novel therapeutic targets. Innovative methods to monitor disease are under investigation and more research is needed to understand the natural history of EoE.
在过去二十年中，嗜酸性食管炎（EoE）已从一个鲜为人知的疾病转变为成人和儿童人群发病的一个重要原因。我们回顾了EoE在诊断、治疗和长期监测方面的最新进展。
基于临床、内镜、组织学、免疫学和遗传学上的相似性，越来越多的人达成共识，不再将质子泵抑制剂反应性食管嗜酸性粒细胞增多症视为与EoE不同的一种疾病。越来越多的研究已确定未治疗疾病的持续时间是食管狭窄形成的一个重要决定因素。已开发出经验性排除饮食的新方法，包括单步、两步、四步和逐步方案，以减少重新引入食物触发因素期间重复进行内镜检查的需求。局部类固醇仍然是药物治疗的主要手段，但正在开发更新的制剂以优化食管给药。正在评估新的疾病活动监测技术，这些技术无需内镜检查即可评估食管炎症活动。自首次发现该疾病以来，对EoE的认识有了显著提高。对其潜在发病机制的探索仍在继续，这导致了诊断标准以及新的治疗靶点的转变。正在研究监测疾病的创新方法，还需要更多研究来了解EoE的自然病程。
