食管嗜酸性粒细胞增多症的分布作为嗜酸性粒细胞性食管炎中质子泵抑制剂反应的预测指标

Distribution of Esophageal Eosinophilia as a Predictor of Proton Pump Inhibitor Response in Eosinophilic Esophagitis.

作者信息

Hartnett Davis A, Muftah Mayssan, Leung Ryan, Hiramoto Brent, Flanagan Ryan, Cai Jennifer X, Lo Wai-Kit, Chan Walter W

机构信息

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts.

出版信息

Clin Gastroenterol Hepatol. 2025 Jul 16. doi: 10.1016/j.cgh.2025.06.032.

DOI:10.1016/j.cgh.2025.06.032

PMID:40680905

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12350050/

Abstract

BACKGROUND & AIMS: The impact of the esophageal eosinophilic distribution pattern on treatment outcomes in eosinophilic esophagitis (EoE) is unclear. We aimed to determine if the eosinophil distribution at index endoscopy predicts proton pump inhibitor (PPI) response in EoE.

METHODS

This was a cohort study of newly diagnosed adult patients with EoE from 3 hospitals. All included patients received ≥8-week PPI trial and underwent repeat biopsies to assess response. Primary analyses compared PPI response between isolated distal disease (≥15 eosinophils/hpf on distal but not proximal biopsies) and proximal/diffuse eosinophilia (≥15 eosinophils/hpf on proximal ± distal biopsies). Secondary analyses categorized patients as distal-predominant (distal >proximal eosinophils by ≥10/hpf), proximal predominant (proximal >distal eosinophils by ≥10/hpf), or even distribution pattern. Multivariable analyses were performed using logistic regression, adjusting for potential confounders.

RESULTS

A total of 266 patients (50.8% male; 89.1% White) met inclusion criteria, including 66 with isolated distal and 200 with proximal/diffuse disease. PPI response was higher among patients with isolated distal disease (histologic remission [<15 eosinophils/hpf post-PPI]: 63.6% vs 44.5%; P = .01; deep remission [<6 eosinophils/hpf]: 54.5% vs 31.0%; P = .001; symptom improvement: 92.4% vs 81.0%; P = .03). On multivariable analyses, isolated distal disease remained independently associated with histologic response (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.10-3.77; P = .02), deep remission (aOR, 2.46; 95% CI, 1.33-4.54; P = .02), and symptom improvement (aOR, 4.1; 95% CI, 1.4-12.01; P = .01). On secondary analyses, proximal-predominant eosinophilia independently predicted PPI histologic nonresponse compared with distal-predominant (aOR, 0.52; 95% CI, 0.28-0.99; P = .04) or any nonproximal (aOR, 0.54; 95% CI, 0.3-0.97; P = .04) pattern.

CONCLUSIONS

Isolated distal eosinophilia at index endoscopy independently predicted PPI response in patients with EoE, whereas proximal-predominant pattern predicted nonresponse. Patterns of esophageal eosinophilic distribution may reflect different disease phenotypes and help guide management.

摘要

背景与目的

嗜酸性粒细胞性食管炎（EoE）中食管嗜酸性粒细胞分布模式对治疗结果的影响尚不清楚。我们旨在确定初次内镜检查时的嗜酸性粒细胞分布是否可预测EoE患者对质子泵抑制剂（PPI）的反应。

方法

这是一项对来自3家医院新诊断的成年EoE患者的队列研究。所有纳入患者均接受了≥8周的PPI试验，并进行了重复活检以评估反应。主要分析比较了孤立性远端疾病（远端活检每高倍视野≥15个嗜酸性粒细胞，近端活检无）和近端/弥漫性嗜酸性粒细胞增多（近端和/或远端活检每高倍视野≥15个嗜酸性粒细胞）患者的PPI反应。次要分析将患者分为远端为主型（远端嗜酸性粒细胞比近端多≥10个/高倍视野）、近端为主型（近端嗜酸性粒细胞比远端多≥10个/高倍视野）或均匀分布型。使用逻辑回归进行多变量分析，并对潜在混杂因素进行调整。

结果

共有266例患者（50.8%为男性；89.1%为白人）符合纳入标准，其中66例为孤立性远端疾病，200例为近端/弥漫性疾病。孤立性远端疾病患者的PPI反应更高（组织学缓解[PPI治疗后每高倍视野<15个嗜酸性粒细胞]：63.6%对44.5%；P = 0.01；深度缓解[每高倍视野<6个嗜酸性粒细胞]：54.5%对31.0%；P = 0.001；症状改善：92.4%对81.0%；P = 0.03）。在多变量分析中，孤立性远端疾病仍与组织学反应独立相关（调整后的优势比[aOR]，2.04；95%置信区间[CI]，1.10 - 3.77；P = 0.02）、深度缓解（aOR，2.46；95% CI，1.33 - 4.54；P = 0.02）和症状改善（aOR，4.1；95% CI，1.4 - 12.01；P = 0.01）。在次要分析中，与远端为主型（aOR，0.52；95% CI，0.28 - 0.99；P = 0.04）或任何非近端型（aOR，0.54；95% CI，0.3 - 0.97；P = 0.04）模式相比，近端为主型嗜酸性粒细胞增多独立预测PPI组织学无反应。