Department of Pediatrics, Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Pediatrics, Division of Allergy/Immunology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
J Leukoc Biol. 2018 Jul;104(1):31-40. doi: 10.1002/JLB.5MR1017-395R. Epub 2018 Jan 29.
Eosinophilic esophagitis (EoE) is an immune/antigen-mediated, progressive fibrostenotic disease characterized by symptoms of esophageal dysfunction and abnormal eosinophilic infiltration in the esophagus. Despite current treatment modalities of dietary antigen elimination or topical corticosteroids, a subset of patients do not have clinical or histologic response. Even with resolution of superficial epithelial eosinophilia, patients may still have progressive subepithelial fibrosis, which may lead to esophageal strictures over time. Histologic identification of subepithelial fibrosis requires deep esophageal biopsies, which are not routinely obtained. Herein, we review the challenges in diagnosing and treating fibrosis in EoE. We propose the novel concept of vitamin D supplementation to treat fibrosis in EoE through downregulation of profibrotic mediator, transforming growth factor-beta.
嗜酸性粒细胞性食管炎（EoE）是一种免疫/抗原介导的、进行性纤维狭窄性疾病，其特征是食管功能障碍和食管内异常嗜酸性粒细胞浸润的症状。尽管目前采用饮食抗原消除或局部皮质类固醇治疗，但仍有一部分患者没有临床或组织学反应。即使上皮嗜酸性粒细胞增多得到缓解，患者仍可能存在进行性黏膜下纤维化，随着时间的推移可能导致食管狭窄。黏膜下纤维化的组织学鉴定需要进行深部食管活检，但通常不进行这种活检。在此，我们回顾了诊断和治疗 EoE 纤维化的挑战。我们提出了通过下调致纤维化介质转化生长因子-β来补充维生素 D 治疗 EoE 纤维化的新概念。
