Dickerson Andrew, Dellon Evan S, Aceves Seema S
Division of Allergy, Immunology, Department of Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, California; Division of Gastroenterology, Department of Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, California.
Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
Ann Allergy Asthma Immunol. 2025 Aug;135(2):143-154. doi: 10.1016/j.anai.2025.05.016. Epub 2025 May 18.
Eosinophilic gastrointestinal disorders, including eosinophilic esophagitis, are chronic T2-mediated diseases. Establishing a diagnosis and initiating treatment are crucial to limit disease progression that may lead to tissue remodeling and the development of strictures that significantly affect patients' quality of life. Expert consensus guidelines provide a framework for treating eosinophilic esophagitis with diet elimination, proton pump inhibitors, swallowed topical steroids, or dupilumab, and for monitoring with sedated endoscopy for gross and histologic evaluation. Although this provides an established algorithm for treating and monitoring eosinophilic esophagitis, there is less established research for the rarer eosinophilic gastrointestinal disorders (eosinophilic gastritis, enteritis, and colitis). Research advancements continue rapidly to emerge, identifying potential biomarkers, therapeutic targets, and monitoring strategies. In this article, we review the currently accepted methods for treating and monitoring eosinophilic gastrointestinal disorders with a focus on eosinophilic esophagitis, assess methods currently under investigation, and provide an aspirational vision for future disease management with a streamlined algorithm of personalized medicine and less invasive monitoring.
嗜酸性粒细胞性胃肠道疾病，包括嗜酸性粒细胞性食管炎，是慢性2型介导的疾病。确立诊断并开始治疗对于限制疾病进展至关重要，疾病进展可能导致组织重塑以及狭窄形成，而狭窄会显著影响患者的生活质量。专家共识指南为使用饮食排除法、质子泵抑制剂、吞咽局部类固醇或度普利尤单抗治疗嗜酸性粒细胞性食管炎，以及使用镇静内镜进行大体和组织学评估监测提供了框架。尽管这为治疗和监测嗜酸性粒细胞性食管炎提供了既定的算法，但对于较罕见的嗜酸性粒细胞性胃肠道疾病（嗜酸性粒细胞性胃炎、肠炎和结肠炎）的研究较少。研究进展迅速不断涌现，确定了潜在的生物标志物、治疗靶点和监测策略。在本文中，我们回顾了目前公认的治疗和监测嗜酸性粒细胞性胃肠道疾病的方法，重点是嗜酸性粒细胞性食管炎，评估目前正在研究的方法，并通过个性化医疗的简化算法和侵入性较小的监测为未来疾病管理提供理想愿景。
