Division of Allergy and Immunology, University of California, San Diego, La Jolla, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Calif; Rady Children's Hospital, San Diego, Calif.
Division of Allergy and Immunology, University of California, San Diego, La Jolla, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Calif; Altman Clinical Translational Research Institute, University of California, San Diego, La Jolla, Calif; Rady Children's Hospital, San Diego, Calif.
J Allergy Clin Immunol. 2019 Oct;144(4):1050-1057.e5. doi: 10.1016/j.jaci.2019.06.015. Epub 2019 Jun 28.
Eosinophilic esophagitis (EoE) is a chronic and increasingly prevalent antigen-driven disease. There is a paucity of information on long-term course in children.
We sought to understand the longitudinal trajectory of pediatric EoE during routine clinical care.
We prospectively enrolled children into an EoE database and reviewed their medical and pathologic records over 13 years.
From 2011 to 2015, 146 children with EoE seen for their first visit at our center had 2 or more years of follow-up and 3 or more endoscopies over an average follow-up period of 5.13 years (range, 2-13 years). Longitudinal eosinophilic inflammation during treatment demonstrated 3 patterns over time. Children with less than 15 eosinophils/high-power field (hpf) for greater than 75% of their follow-up period were termed continuous responders (CRs). Children with waxing and waning inflammation of less than 15 eosinophils/hpf for less than 75% but 25% or more of the follow-up period were termed intermittent responders (IRs). Nonresponders (NRs) were defined as having less than 15 eosinophils/hpf for less than 25% of their follow-up. Fifty-nine (40%) of 146 patients were CRs, 65 (45%) of 146 were IRs, and 22 (15%) of 146 were NRs. CRs differed from IRs and NRs on the parameter of male/female ratio (1:1 in CRs, 4:1 in IRs, and 6:1 in NRs; P < .001) and in their initial response to any therapy, including proton pump inhibitors (P < .001). Endoscopic severity correlated with esophageal eosinophilia (r = 0.73, P < .001). On multivariate analysis, female sex and initial therapeutic response to medications or elimination diet were associated with long-term control of esophageal eosinophilia.
Long-term pediatric EoE followed 3 different longitudinal trajectories of inflammation. The long-term histologic groups differed significantly in biological sex and initial therapeutic response.
嗜酸性食管炎（EoE）是一种慢性、日益流行的抗原驱动性疾病。目前关于儿童的长期病程信息较少。
我们旨在了解在常规临床护理中儿童 EoE 的纵向病程。
我们前瞻性地将儿童纳入 EoE 数据库，并在 13 年期间回顾他们的医疗和病理记录。
2011 年至 2015 年，在我们中心首次就诊的 146 例 EoE 患儿有 2 年或更长时间的随访和 3 次或更多次内镜检查，平均随访时间为 5.13 年（范围，2-13 年）。治疗期间纵向嗜酸性粒细胞炎症随时间表现出 3 种模式。在随访期超过 75%的时间内，有 15 个嗜酸性粒细胞/高倍镜视野（hpf）以下的患儿被称为持续缓解者（CR）。在随访期少于 75%但 25%或更多时间内，有 15 个嗜酸性粒细胞/hpf 以下的间歇性缓解者（IR）。未缓解者（NR）定义为在随访期间有 15 个嗜酸性粒细胞/hpf 以下的时间少于 25%。146 例患者中，59 例（40%）为 CR，65 例（45%）为 IR，22 例（15%）为 NR。CR 在男女比例参数上与 IR 和 NR 不同（CR 为 1:1，IR 为 4:1，NR 为 6:1；P < 0.001），在初始对任何治疗的反应上也不同，包括质子泵抑制剂（P < 0.001）。内镜严重程度与食管嗜酸性粒细胞增多相关（r = 0.73，P < 0.001）。在多变量分析中，女性和初始药物或消除饮食治疗反应与食管嗜酸性粒细胞长期控制相关。
儿童 EoE 的长期随访表现出 3 种不同的炎症纵向轨迹。长期的组织学组在生物学性别和初始治疗反应上存在显著差异。
