Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
Semin Immunopathol. 2021 Jun;43(3):319-335. doi: 10.1007/s00281-021-00855-y. Epub 2021 Jun 7.
Despite dramatic advances in our understanding of the pathogenesis and course of disease in the relatively short timeframe since the discovery and first description of eosinophilic esophagitis (EoE) less than three decades ago, many open questions remain to be elucidated. For instance, we will need to better characterize atypical clinical presentations of EoE and other forms of esophageal inflammatory conditions with often similar clinical presentations, nut fulfilling current diagnostic criteria for EoE and to determine their significance and interrelationship with genuine EoE. In addition, the interrelationship of EoE with other immune-mediated diseases remains to be clarified. Hopefully, a closer look at the role of environmental factors and their interaction with genetic susceptibility often in context of atopic predisposition may enable identifying the candidate substances/agents/allergens and potentially earlier (childhood) events to trigger the condition. It appears plausible to assume that in the end-comparable to current concepts in other immune-mediated chronic diseases, such as for instance inflammatory bowel disease or asthma bronchiale-we will not be rewarded with the identification of a "one-and-only" underlying pathogenetic trigger factor, with causal responsibility for the disease in each and every EoE patient. Rather, the relative contribution and importance of intrinsic susceptibility, i.e., patient-driven factors (genetics, aberrant immune response) and external trigger factors, such as food (or aero-) allergens as well as early childhood events (e.g., infection and exposure to antibiotics and other drugs) may substantially differ among given individuals with EoE. Accordingly, selection and treatment duration of medical therapy, success rates and extent of required restriction in dietary treatment, and the need for mechanical treatment to address strictures and stenosis require an individualized approach, tailored to each patient. With the advances of emerging treatment options, the importance of such an individualized and patient-centered assessment will increase even further.
尽管在不到三十年的时间里，人们对嗜酸性粒细胞性食管炎（EoE）的发病机制和疾病进程有了显著的了解，但仍有许多悬而未决的问题需要阐明。例如，我们需要更好地描述 EoE 和其他具有相似临床表现的食管炎症性疾病的非典型临床表现，这些疾病目前满足 EoE 的诊断标准，并确定它们与真正的 EoE 的意义和相互关系。此外，EoE 与其他免疫介导性疾病的相互关系仍需澄清。希望仔细研究环境因素及其与遗传易感性的相互作用，通常是在特应性倾向的背景下，能够确定候选物质/剂/过敏原，以及可能更早（儿童时期）的事件来引发这种情况。可以合理地假设，最终——类似于其他免疫介导性慢性疾病的当前概念，例如炎症性肠病或支气管哮喘——我们不会因为发现一个“唯一”的潜在发病诱因而得到回报，这个诱因对每个 EoE 患者的疾病都负有因果责任。相反，内在易感性的相对贡献和重要性，即患者驱动因素（遗传、异常免疫反应）和外部触发因素，如食物（或空气）过敏原以及儿童早期事件（例如感染和接触抗生素和其他药物），在不同的 EoE 患者中可能有很大差异。因此，医学治疗的选择和治疗持续时间、成功率以及饮食治疗所需限制的程度，以及解决狭窄和狭窄所需机械治疗的必要性，都需要个体化的方法，针对每个患者量身定制。随着新兴治疗选择的进步，这种个体化和以患者为中心的评估的重要性将进一步增加。
