Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2021 Jun;62(6):487-493. doi: 10.3349/ymj.2021.62.6.487.
The prevalence and incidence of eosinophilic esophagitis (EoE) are increasing worldwide. Despite increased understanding of inflammatory pathogenesis, changes in endoscopic features after treatment of EoE have not been clearly described. We aimed to investigate the reversibility of endoscopic features of EoE after treatment.
Out of 58 adult subjects who were diagnosed with EoE at the Yonsei University Health System from July 2006 to August 2019, we recruited 33 subjects (30 males; mean age: 42 years) whose pre-treatment and post-treatment endoscopic images were available. Endoscopic features included both inflammatory and fibrostenotic features. Exudate, edema, furrow, and crepe paper-like mucosa were classified as inflammatory features. Ring and stricture were classified as fibrostenotic features. We compared changes in endoscopic features after treatment for EoE.
After treatment, clinical symptoms improved in all patients. The following endoscopic features were observed before treatment: furrow (81.8%), edema (90.9%), exudate (42.4%), ring (27.3%), crepe paper-like mucosa (15.2%), and stricture (3.0%). Endoscopic remission was achieved in 21 patients (63.6%). Inflammatory features were reversible (72.7%, <0.001), whereas fibrostenotic features were not (10%, =0.160). Exudate had resolved in 92.9% of patients, edema in 70% and furrow in 88.9%. Ring and stricture persisted in almost all of the patients (9/10) who had these endoscopic features before treatment.
We outlined the reversibility of endoscopic inflammatory features of EoE. Fibrostenotic features were irreversible after esophageal remodeling in patients with EoE. However, further validation studies with long-term follow-up are needed.
嗜酸细胞性食管炎（EoE）的患病率和发病率在全球范围内呈上升趋势。尽管人们对炎症发病机制的认识有所提高，但 EoE 治疗后内镜特征的变化尚未得到明确描述。我们旨在研究 EoE 治疗后内镜特征的可逆性。
在 2006 年 7 月至 2019 年 8 月期间，在延世大学健康系统诊断为 EoE 的 58 名成年患者中，我们招募了 33 名（30 名男性；平均年龄：42 岁）患者，他们的治疗前和治疗后内镜图像均可用。内镜特征包括炎症和纤维狭窄特征。渗出物、水肿、皱襞和绉纸样黏膜被归类为炎症特征。环和狭窄被归类为纤维狭窄特征。我们比较了 EoE 治疗后内镜特征的变化。
治疗后，所有患者的临床症状均有所改善。治疗前观察到以下内镜特征：皱襞（81.8%）、水肿（90.9%）、渗出物（42.4%）、环（27.3%）、绉纸样黏膜（15.2%）和狭窄（3.0%）。21 名患者（63.6%）达到内镜缓解。炎症特征是可逆的（72.7%，<0.001），而纤维狭窄特征是不可逆转的（10%，=0.160）。92.9%的患者渗出物消失，70%的患者水肿消失，88.9%的患者皱襞消失。治疗前有环和狭窄内镜特征的患者中，几乎所有患者（9/10）的这些内镜特征仍存在。
我们描述了 EoE 内镜炎症特征的可逆性。EoE 患者食管重塑后，纤维狭窄特征不可逆转。然而，需要进一步进行长期随访的验证研究。
