Department of Medicine, Hyogo-Brain and Heart Center at Himeji, Japan.
Department of Medicine, Steel Memorial Hirohata Hospital, Japan.
Intern Med. 2023 Jan 1;62(1):1-10. doi: 10.2169/internalmedicine.8417-21. Epub 2021 Oct 19.
Eosinophilic gastrointestinal diseases are delayed-type chronic allergic disorders that show gastrointestinal eosinophil dense infiltration, with an exaggerated Th2-type immune reaction considered to be an important mechanism. These diseases can be roughly divided into two types: eosinophilic esophagitis, mainly found in young and middle-aged men, and eosinophilic gastroenteritis, which is found in both genders equally. A diagnosis of eosinophilic esophagitis is suspected when characteristic endoscopic findings, including longitudinal furrows and rings, are noted. However, characteristic endoscopic abnormalities are rarely found in cases with eosinophilic gastroenteritis, so multiple biopsy sampling from the apparently normal gastrointestinal mucosal surface is important for making an accurate diagnosis. The administration of systemic glucocorticoid is the standard treatment for eosinophilic gastroenteritis, while acid inhibitors and topical glucocorticoid swallowing therapy are effective for eosinophilic esophagitis. Anti-cytokine therapies for eosinophilic gastrointestinal diseases are currently under development.
嗜酸粒细胞性胃肠道疾病是一种迟发型慢性过敏性疾病，表现为胃肠道嗜酸粒细胞密集浸润，过度的 Th2 型免疫反应被认为是其重要发病机制。这些疾病大致可分为两种类型：嗜酸粒细胞性食管炎主要发生在中青年男性，嗜酸粒细胞性胃肠炎则在两性中发病率均等。当观察到特征性内镜表现，如纵向皱襞和环形改变时，怀疑诊断为嗜酸粒细胞性食管炎。然而，嗜酸粒细胞性胃肠炎病例很少出现特征性内镜异常，因此对明显正常的胃肠道黏膜表面进行多次活检取样对于做出准确诊断很重要。全身糖皮质激素的应用是嗜酸粒细胞性胃肠炎的标准治疗方法，而酸抑制剂和局部糖皮质激素吞咽疗法对嗜酸粒细胞性食管炎有效。目前正在开发针对嗜酸粒细胞性胃肠道疾病的抗细胞因子治疗方法。
