Division on Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, University of Athens, Children's Hospital "Agia Sofia", Athens, Greece.
Division on Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, University of Athens, Children's Hospital "Agia Sofia", Athens, Greece,
Ann Nutr Metab. 2018;73 Suppl 4:18-28. doi: 10.1159/000493668. Epub 2019 Feb 19.
Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically, by symptoms related to the dysfunction of the involved segment(s) of the GI tract, and histologically, by dense eosinophilic inflammation, in the absence of an identifiable secondary cause. The group of EGIDs comprises eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC). EoE is the most common and the best described EGID compared to EG, EGE, and EC. The clinical presentation of the EGIDs differs depending on the location and the extent of the eosinophilic infiltration in the GI tract, as well as its depth through the bowel wall. In the absence of biological markers, the diagnosis is based on the combination of clinical symptoms with the histological features of EGIDs, after the exclusion of secondary causes of eosinophilic inflammation of the GI tract. Treatment is individualized and includes elimination diets (mainly empiric or elemental) and/or drugs, according to the involved GI segment: proton pump inhibitors or local steroids in EoE; local or oral systemic steroids in EG/EGE limited to the duodenum; oral systemic steroids in EGE with lower small intestine and/or colon involvement. In patients with EoE, maintenance treatment with lower doses may be considered following histological remission with the means of drugs. In patients treated with elimination diets, disease food triggers identified during food reintroduction need to be further eliminated. Esophageal stenosis despite medical treatment requires endoscopic dilation, while the use of thiopurines or anti-TNF drugs may be considered in refractory or steroid-dependent EGID (other than EoE). The aim of this review is to provide the available evidence on each of the above disorders, to aid clinicians to interpret the clinical manifestations and the laboratory findings and choose the best available treatment option.
嗜酸粒细胞性胃肠道疾病（EGID）是一组胃肠道（GI）慢性炎症性疾病，其临床特征为受累胃肠道节段功能障碍相关症状，组织学特征为无明确继发原因的致密嗜酸性粒细胞炎症。EGID 包括嗜酸粒细胞性食管炎（EoE）、嗜酸粒细胞性胃炎（EG）、嗜酸粒细胞性胃肠炎（EGE）和嗜酸粒细胞性结肠炎（EC）。与 EG、EGE 和 EC 相比，EoE 是最常见和描述最详细的 EGID。EGID 的临床表现取决于 GI 道嗜酸粒细胞浸润的部位和程度，以及其在肠壁中的深度。在没有生物学标志物的情况下，诊断基于 EGID 的临床症状与组织学特征相结合，排除 GI 道嗜酸粒细胞炎症的继发原因。治疗是个体化的，根据受累的 GI 节段包括消除饮食（主要是经验性或元素性）和/或药物：质子泵抑制剂或局部类固醇在 EoE 中；局部或口服全身类固醇在局限于十二指肠的 EG/EGE 中；口服全身类固醇在累及小肠下段和/或结肠的 EGE 中。对于 EoE 患者，在药物治疗达到组织学缓解后，可以考虑用较低剂量维持治疗。对于接受消除饮食治疗的患者，在重新引入食物时发现的疾病食物触发因素需要进一步消除。尽管进行了药物治疗，但仍存在食管狭窄，需要进行内镜扩张，对于难治性或依赖类固醇的 EGID（EoE 除外），可以考虑使用硫唑嘌呤或抗 TNF 药物。本综述的目的是提供上述每种疾病的现有证据，以帮助临床医生解释临床表现和实验室发现，并选择最佳的治疗方案。
