Kim Ga Hee, Park Young Soo, Jung Kee Wook, Kim Mimi, Na Hee Kyong, Ahn Ji Yong, Lee Jeong Hoon, Kim Do Hoon, Choi Kee Don, Song Ho June, Lee Gin Hyug, Dellon Evan S, Jung Hwoon-Yong
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Asan Digestive Disease Research I nstitute, Seoul, Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Neurogastroenterol Motil. 2019 Oct 30;25(4):525-533. doi: 10.5056/jnm19066.
BACKGROUND/AIMS: The epidemiology and pathogenesis of eosinophilic esophagitis (EoE) remain unclear in Asian countries. We investigated clinicopathological characteristics and diagnostic trends of EoE, and evaluated 3 tissue biomarkers for correlation with disease activity and treatment response in Korean patients with EoE.
We retrospectively reviewed 25 271 esophageal biopsies performed during upper endoscopies between 2006 and 2017. We diagnosed EoE based on ≥ 15 eosinophils/high-power field (HPF) and, symptoms of esophageal dysfunction. We performed immunohistochemical analysis for tryptase, eosinophilic derived neurotoxin (EDN), and eotaxin-3.
We diagnosed EoE in 72 patients (53 men and 19 women; mean age, 46.2 years) with presenting symptoms of, dysphagia (15.3%), epigastric pain (31.9%), and heartburn (30.6%). The diagnostic rate of EoE considerably increased between 2006 and 2017, from 0.29 diagnoses to 7.99 diagnoses per 1000 esophageal biopsies ( P < 0.001). The mean peak eosinophil count (PEC) was 56.0 (± 77.8)/HPF. Whereas the EDN (rho = 0.667, P < 0.001) and eotaxin-3 levels (rho = 0.465, P < 0.001) correlated with PEC, tryptase and PEC were weakly correlated (rho = 0.291, P = 0.013). EDN (rho = 0.279, P = 0.017), and tryptase (rho = 0.279, P = 0.033) correlated with the inflammatory score of Eosinophilic Esophagitis Endoscopic Reference Score. Immunohistochemical analysis and changes in tryptase, EDN, and eotaxin-3 levels were associated with histologic and endoscopic improvements.
EoE incidence considerably increased during the 12-year period, regardless of endoscopic esophageal biopsy rate. Tryptase, EDN, and eotaxin-3 levels in esophageal biopsy specimens could be promising biomarkers for disease activity, symptom, and endoscopic response in Korea.
背景/目的：在亚洲国家，嗜酸性粒细胞性食管炎（EoE）的流行病学和发病机制仍不明确。我们调查了EoE的临床病理特征和诊断趋势，并评估了3种组织生物标志物与韩国EoE患者疾病活动度和治疗反应的相关性。
我们回顾性分析了2006年至2017年间上消化道内镜检查时获取的25271份食管活检标本。我们根据每高倍视野（HPF）≥15个嗜酸性粒细胞以及食管功能障碍症状诊断EoE。我们对类胰蛋白酶、嗜酸性粒细胞衍生神经毒素（EDN）和嗜酸性粒细胞趋化因子-3进行了免疫组织化学分析。
我们诊断出72例EoE患者（53例男性和19例女性；平均年龄46.2岁），其症状包括吞咽困难（15.3%）、上腹部疼痛（31.9%）和烧心（30.6%）。2006年至2017年间，EoE的诊断率显著增加，从每1000例食管活检0.29例诊断增加至7.99例诊断（P<0.001）。平均嗜酸性粒细胞峰值计数（PEC）为56.0（±77.8）/HPF。EDN水平（rho = 0.667，P<0.001）和嗜酸性粒细胞趋化因子-3水平（rho = 0.465，P<0.001）与PEC相关，而类胰蛋白酶与PEC呈弱相关（rho = 0.291，P = 0.013）。EDN（rho = 0.279，P = 0.017）和类胰蛋白酶（rho = 0.279，P = 0.033）与嗜酸性粒细胞性食管炎内镜参考评分的炎症评分相关。免疫组织化学分析以及类胰蛋白酶、EDN和嗜酸性粒细胞趋化因子-3水平的变化与组织学和内镜改善相关。
在这12年期间，无论食管内镜活检率如何，EoE的发病率均显著增加。食管活检标本中的类胰蛋白酶、EDN和嗜酸性粒细胞趋化因子-3水平可能是韩国疾病活动度、症状和内镜反应的有前景的生物标志物。
