Okimoto Eiko, Ishimura Norihisa, Ishihara Shunji
Second Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan.
Second Department of Internal Medicine, Shimane University Faculty of Medicine, Izumo, Japan,
Digestion. 2021;102(1):33-40. doi: 10.1159/000511588. Epub 2020 Nov 17.
Eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), part of the spectrum of eosinophilic gastrointestinal disorders (EGID), share pathogenic similarities. We examined differences regarding clinical characteristics and treatment outcomes between EoE and EGE cases.
Two-hundred fifteen EGID patients, including 181 with EoE and 34 with EGE, diagnosed at Shimane University Hospital between February 2011 and March 2019 were enrolled. Information regarding clinical parameters and treatment outcomes was reviewed.
EoE showed significant male predominance (82.3%) as compared with EGE (50.0%) (p < 0.001). Furthermore, patients with EoE were significantly older and had a higher body mass index (24.8 ± 4.0 vs. 22.2 ± 4.3, p < 0.05). Over 90% of the EoE patients were initially given proton pump inhibitor (PPI) treatment, of whom 73.2% showed clinical and histological remission. Vonoprazan, a more potent acid inhibitor than PPI, was effective in two-thirds of the nonresponsive EoE patients initially treated with a PPI. In contrast, oral glucocorticoid administration was mainly given to patients with EGE (58.8%). Of 13 EGE patients treated with a food-elimination diet, responsible foods were successfully identified in 9, with 7 controlled in a state of remission without glucocorticoid therapy.
We found different clinical characteristics and treatment strategies in the present EoE and EGE cases. Most of the EoE patients responded to and were maintained by acid suppressive therapy, using PPI or vonoprazan. For EGE patients, glucocorticoid administration was mainly used though food-elimination diet therapy also showed beneficial effects.
嗜酸性粒细胞性食管炎（EoE）和嗜酸性粒细胞性胃肠炎（EGE）是嗜酸性粒细胞性胃肠道疾病（EGID）谱系的一部分，具有相似的发病机制。我们研究了EoE和EGE病例在临床特征和治疗结果方面的差异。
纳入2011年2月至2019年3月在岛根大学医院确诊的215例EGID患者，其中181例为EoE，34例为EGE。回顾了临床参数和治疗结果的相关信息。
与EGE（50.0%）相比，EoE男性占比显著更高（82.3%）（p<0.001）。此外，EoE患者年龄显著更大，体重指数更高（24.8±4.0 vs. 22.2±4.3，p<0.05）。超过90%的EoE患者最初接受质子泵抑制剂（PPI）治疗，其中73.2%实现了临床和组织学缓解。沃克帕唑，一种比PPI更强效的酸抑制剂，对三分之二最初接受PPI治疗但无反应的EoE患者有效。相比之下，口服糖皮质激素主要用于EGE患者（58.8%）。在13例接受食物排除饮食治疗的EGE患者中，9例成功确定了相关食物，7例在未使用糖皮质激素治疗的情况下处于缓解状态。
我们发现当前EoE和EGE病例具有不同的临床特征和治疗策略。大多数EoE患者对使用PPI或沃克帕唑的抑酸治疗有反应并得以维持。对于EGE患者，主要使用糖皮质激素治疗，不过食物排除饮食疗法也显示出有益效果。
