School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Newcastle, NSW, Australia.
Faculty of Health and Medicine, University of Newcastle, HMRI Building, New Lambton, NSW, Australia.
Lancet Gastroenterol Hepatol. 2018 Apr;3(4):271-280. doi: 10.1016/S2468-1253(18)30005-0. Epub 2018 Mar 7.
Under normal physiological conditions, eosinophils are present throughout the gastrointestinal tract distal to the squamous oesophagus. Increases in their numbers signify primary and secondary eosinophilic conditions. The rare primary eosinophilic diseases eosinophilic gastroenteritis and eosinophilic colitis affect fewer than ten in 100 000 people, and are characterised by numerous mucosal eosinophils, distributed in sheets and sometimes extending from the mucosa into the submucosa. Pathogenesis of these diseases is poorly understood, but food allergies and intestinal dysbiosis have been implicated. Presentation ranges from vague abdominal symptoms and systemic complaints to, rarely, an acute abdomen with intestinal obstruction. Diagnosis is made from mucosal biopsy samples taken at endoscopy or from surgically resected specimens that demonstrate substantially increased numbers of eosinophils. Eosinophilia secondary to other conditions, such as pathogenic infections, must be excluded. Subtle eosinophilia has also been identified in the duodenum in functional dyspepsia and in the colon in spirochaetosis. Treatment of eosinophilic gastroenteritis and eosinophilic colitis is based on evidence from case reports and small case series, and first-line therapy includes empirical food-elimination diets and single courses of steroids, whereas relapsing or refractory disease might respond to steroid-sparing immunosuppressive agents and biological agents. The progression of disease in eosinophilic gastroenteritis and eosinophilic colitis is variable: a considerable number of patients have just one episode without relapse, whereas others have relapsing-remitting or chronic disease. Primary and secondary eosinophilia in the gastrointestinal tract is increasingly recognised as a clinical conundrum waiting to be solved.
在正常生理条件下，嗜酸性粒细胞存在于食管鳞状远端的整个胃肠道中。其数量的增加表明原发性和继发性嗜酸性粒细胞条件。罕见的原发性嗜酸性粒细胞疾病，如嗜酸性胃肠炎和嗜酸性结肠炎，影响不到每 10 万人中的 10 人，其特征是大量黏膜嗜酸性粒细胞，呈片状分布，有时从黏膜延伸到黏膜下层。这些疾病的发病机制尚不清楚，但食物过敏和肠道菌群失调已被牵连。表现范围从模糊的腹部症状和全身症状到罕见的急性肠梗阻性腹痛。诊断是通过内镜下黏膜活检或手术切除标本得出的，这些标本显示嗜酸性粒细胞数量显著增加。必须排除继发于其他疾病（如感染性疾病）的嗜酸性粒细胞增多症。在功能性消化不良的十二指肠和螺旋体病的结肠中也发现了轻微的嗜酸性粒细胞增多。嗜酸性胃肠炎和嗜酸性结肠炎的治疗基于病例报告和小病例系列的证据，一线治疗包括经验性的食物消除饮食和单一疗程的类固醇，而复发或难治性疾病可能对类固醇保留免疫抑制剂和生物制剂有反应。嗜酸性胃肠炎和嗜酸性结肠炎的疾病进展是可变的：相当多的患者只有一次发作而没有复发，而其他患者则有复发缓解或慢性疾病。胃肠道的原发性和继发性嗜酸性粒细胞增多症越来越被认为是一个有待解决的临床难题。
