Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Center for Pediatric Eosinophilic Diseases, Division of Gastroenterology and Hepatology & Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Gastroenterology. 2018 Oct;155(4):1022-1033.e10. doi: 10.1053/j.gastro.2018.07.009. Epub 2018 Sep 6.
BACKGROUND & AIMS: Over the last decade, clinical experiences and research studies raised concerns regarding use of proton pump inhibitors (PPIs) as part of the diagnostic strategy for eosinophilic esophagitis (EoE). We aimed to clarify the use of PPIs in the evaluation and treatment of children and adults with suspected EoE to develop updated international consensus criteria for EoE diagnosis.
A consensus conference was convened to address the issue of PPI use for esophageal eosinophilia using a process consistent with standards described in the Appraisal of Guidelines for Research and Evaluation II. Pediatric and adult physicians and researchers from gastroenterology, allergy, and pathology subspecialties representing 14 countries used online communications, teleconferences, and a face-to-face meeting to review the literature and clinical experiences.
Substantial evidence documented that PPIs reduce esophageal eosinophilia in children, adolescents, and adults, with several mechanisms potentially explaining the treatment effect. Based on these findings, an updated diagnostic algorithm for EoE was developed, with removal of the PPI trial requirement.
EoE should be diagnosed when there are symptoms of esophageal dysfunction and at least 15 eosinophils per high-power field (or approximately 60 eosinophils per mm) on esophageal biopsy and after a comprehensive assessment of non-EoE disorders that could cause or potentially contribute to esophageal eosinophilia. The evidence suggests that PPIs are better classified as a treatment for esophageal eosinophilia that may be due to EoE than as a diagnostic criterion, and we have developed updated consensus criteria for EoE that reflect this change.
在过去十年中，临床经验和研究表明质子泵抑制剂（PPIs）的使用可能会影响嗜酸性粒细胞性食管炎（EoE）的诊断策略。我们旨在阐明质子泵抑制剂在疑似 EoE 患儿和成人评估及治疗中的应用，从而制定 EoE 诊断的国际共识标准更新版。
采用与评估、研究与评价 II 标准中描述的标准一致的流程，召开了一次共识会议来解决质子泵抑制剂在食管嗜酸性粒细胞增多症中的应用问题。来自 14 个国家的儿科和成人胃肠病学、过敏和病理学专业的医生和研究人员使用在线交流、电话会议和面对面会议来回顾文献和临床经验。
大量证据证明质子泵抑制剂可减少儿童、青少年和成人的食管嗜酸性粒细胞，其潜在治疗机制有多种。基于这些发现，开发了更新的 EoE 诊断算法，取消了 PPI 试验要求。
当存在食管功能障碍症状，且食管活检显示至少 15 个嗜酸性粒细胞/高倍视野（或约 60 个嗜酸性粒细胞/毫米），且排除了其他可能导致或有助于食管嗜酸性粒细胞增多的非 EoE 疾病后，应诊断 EoE。有证据表明，质子泵抑制剂最好被归类为治疗可能由 EoE 引起的食管嗜酸性粒细胞增多症的药物，而不是诊断标准，我们已经制定了 EoE 的共识标准更新版，以反映这一变化。
