From the Stanford School of Medicine, Stanford, CA.
the University of Virginia Health System, Charlottesville, VA.
J Pediatr Gastroenterol Nutr. 2022 Oct 1;75(4):e67-e74. doi: 10.1097/MPG.0000000000003580. Epub 2022 Jul 28.
Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory disease characterized by eosinophilic infiltration of esophageal tissue. Subtyping of EoE patients could be useful in predicting therapeutic response. We propose clinical subtypes, apply them to our pediatric EoE population retrospectively, and assess therapy choices and remission at one year.
A retrospective chart review of pediatric patients diagnosed with EoE was conducted. Patients were grouped into proposed subtypes (severe, allergic, fibrostenotic, inflammatory, unclassified) based on presenting characteristics. The primary outcome was histologic remission, which was defined <15 eosinophils/high-powered-field (hpf) at the closest visit 1 year postdiagnosis.
Subtyping was possible in 242 of 256 patients and follow-up histological data were available in 75 subjects. The majority had an overlap in phenotype with 17% severe, 77% allergic, 15% fibrostenotic, 60% inflammatory, and 5% unclassified, whereas 45% of the cohort were assigned to a unique subtype. At 1 year, 43/75 (57%) of patients achieved histologic remission, with an overall average decrease of 33 (IQR -47, -12) eosinophils/hpf across the entire cohort. There was no difference in remission rates among subtypes. First-line therapy review revealed higher rates of proton pump inhibitor (PPI) ± topical steroids utilization in severe patients, while topical steroids were prescribed preferentially over dietary therapy in the fibrostenotic subtype.
There were no observed differences in remission rates at 1 year among clinically defined subtypes of EoE, although this could be attributed to overlapping subtypes. Most patients responded well to medical therapy. Larger scale prospective studies designed to subtype patients and protocolize treatment may help personalize the approach to EoE management.
嗜酸性食管炎（EoE）是一种免疫介导的炎症性疾病，其特征是食管组织中有嗜酸性粒细胞浸润。EoE 患者的亚型分类可能有助于预测治疗反应。我们提出了临床亚型，对我们的儿科 EoE 人群进行回顾性应用，并评估一年时的治疗选择和缓解情况。
对诊断为 EoE 的儿科患者进行回顾性图表审查。根据表现特征将患者分为拟议的亚型（严重型、过敏型、纤维狭窄型、炎症型、未分类型）。主要结局是组织学缓解，定义为在诊断后 1 年最近一次就诊时，<15 个嗜酸性粒细胞/高倍视野（hpf）。
在 256 名患者中，242 名可以进行亚型分类，75 名患者有随访的组织学数据。大多数患者表现出表型重叠，17%为严重型，77%为过敏型，15%为纤维狭窄型，60%为炎症型，5%为未分类型，而 45%的患者被分配到一个独特的亚型。在 1 年时，75 名患者中有 43/75（57%）达到组织学缓解，整个队列的平均嗜酸性粒细胞计数下降 33（IQR-47，-12）个/hpf。各亚型的缓解率无差异。一线治疗回顾显示，严重型患者更倾向于使用质子泵抑制剂（PPI）±局部类固醇，而纤维狭窄型患者更倾向于使用局部类固醇而不是饮食治疗。
在 1 年时，根据临床定义的 EoE 亚型，缓解率没有观察到差异，尽管这可能归因于亚型重叠。大多数患者对药物治疗反应良好。设计对患者进行亚型分类并制定治疗方案的更大规模前瞻性研究可能有助于实现 EoE 管理的个体化方法。
