Mishiro Tsuyoshi, Ishimura Norihisa, Ishihara Shunji, Kinoshita Yoshikazu
Department of Gastroenterology and Hepatology, Shimane University, Faculty of Medicine.
Nihon Yakurigaku Zasshi. 2018;152(4):175-180. doi: 10.1254/fpj.152.175.
Eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), which are included in eosinophilic gastrointestinal disorders (EGIDs), are allergic gastrointestinal diseases mainly caused by food allergens, which features dense infiltration of eosinophiles in the gastrointestinal mucosa. A possible mechanism of these diseases are Th2 type allergic reactions, including IL-5, IL-13, and IL-15, thymic stromal protein (TSLP), and eotaxin 3, which are considered to have important roles. The number of patients with EoE is rapidly increasing in both Western and Asian countries. In Japan, a research group of the Ministry of Health, Labor and Welfare has announced recommendations for the diagnosis and management of EoE and EGE in 2015. For a diagnosis of EoE, endoscopic abnormalities and histological confirmation of dense eosinophile infiltration in the esophageal epithelial layer are important, in addition to identifying dysphagia symptoms. As for eosinophilic gastroenteritis, blood test findings are more useful and the role of an endoscopic examination is reduced. Glucocorticoid administration is standard treatment for these diseases, while proton pump inhibitors are frequently effective for EoE. As for EoE, on the one hand, a variety of studies have been performed and new findings collected. On the other hand, information concerning EGE is limited and additional evidence is needed to establish effective treatment options.
嗜酸性粒细胞性食管炎(EoE)和嗜酸性粒细胞性胃肠炎(EGE)属于嗜酸性粒细胞性胃肠道疾病(EGIDs),是主要由食物过敏原引起的过敏性胃肠道疾病,其特征是胃肠道黏膜中有大量嗜酸性粒细胞浸润。这些疾病的一种可能机制是Th2型过敏反应,包括白细胞介素-5(IL-5)、白细胞介素-13(IL-13)和白细胞介素-15、胸腺基质淋巴细胞生成素(TSLP)以及嗜酸性粒细胞趋化因子3,它们被认为具有重要作用。在西方国家和亚洲国家,EoE患者的数量都在迅速增加。在日本,厚生劳动省的一个研究小组于2015年公布了EoE和EGE的诊断及管理建议。对于EoE的诊断,除了确定吞咽困难症状外,内镜检查异常以及食管上皮层嗜酸性粒细胞密集浸润的组织学确认也很重要。至于嗜酸性粒细胞性胃肠炎,血液检查结果更有用,内镜检查的作用则有所降低。糖皮质激素给药是这些疾病的标准治疗方法,而质子泵抑制剂对EoE通常有效。一方面,针对EoE已经开展了各种研究并收集到了新的发现。另一方面,关于EGE的信息有限,需要更多证据来确定有效的治疗方案。