嗜酸性粒细胞性食管炎研究进展
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摘要
嗜酸性粒细胞性食管炎(EoE)是一种由免疫介导的慢性食管疾病,以食管功能障碍为主要临床表现,主要病理学表现为食管黏膜层大量嗜酸性粒细胞浸润。近年来,EoE的发病率和患病率逐年增长。在儿童患者中,EoE主要以炎症表型存在,而成人患者则以纤维狭窄表型为主要特征。临床和内镜评分系统有助于规范EoE的评估标准。目前对EoE的治疗终点尚存在争议。临床医师需进一步提高对EoE的认识,理解EoE的疾病演变进程,从而更为简单、有效地诊断、评估和治疗EoE。
Eosinophilic esophagitis( EoE) is a chronic,local immune-mediated esophageal disease,characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The incidence and prevalence are increasing rapidly in recent years. Children often present with symptoms and endoscopic patterns of inflammation,whereas most adolescents and adults have manifestations of esophageal fibrosis and stricture.Clinical and endoscopic scoring systems are helpful for standardizing the disease assessment. There is controversy over the optimal treatment endpoint of EoE. Clinicians should improve their understanding of EoE and its progression for effective diagnosis,assessment and treatment of the disease.
Eosinophilic esophagitis( EoE) is a chronic,local immune-mediated esophageal disease,characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The incidence and prevalence are increasing rapidly in recent years. Children often present with symptoms and endoscopic patterns of inflammation,whereas most adolescents and adults have manifestations of esophageal fibrosis and stricture.Clinical and endoscopic scoring systems are helpful for standardizing the disease assessment. There is controversy over the optimal treatment endpoint of EoE. Clinicians should improve their understanding of EoE and its progression for effective diagnosis,assessment and treatment of the disease.
引文
1唐杜鹏,庄则豪.嗜酸性粒细胞性食管炎诊断进展[J].国际消化病杂志,2013,33(5):311-314.
2 Lynch KL, Dhalla S, Chedid V, et al. Gender is a determinative factor in the initial clinical presentation of eosinophilic esophagitis[J]. Dis Esophagus,2016,29(2):174-178.
3 Dellon ES, Liacouras CA. Advances in clinical management of eosinophilic esophagitis[J]. Gastroenterology,2014,147(6):1238-1254.
4 Dellon ES,Hirano I. Epidemiology and Natural History of Eosinophilic Esophagitis[J]. Gastroenterology,2018,154(2):319-332. e3.
5 邵洁,张自力.认识嗜酸细胞性食管炎———从基因学、免疫学到临床诊治[J].临床儿科杂志,2013,31(1):1-4.
6 Straumann A, Katzka DA. Diagnosis and Treatment of Eosinophilic Esophagitis[J]. Gastroenterology,2018,154(2):346-359.
7 黄勤,于成功,邹晓平,等.嗜酸细胞性食管炎的内镜和病理学诊断及鉴别诊断[J].中华消化内镜杂志,2011,28(12):662-663.
8 范颖楠,马洪升.嗜酸细胞性食管炎研究进展[J].国际消化病杂志,2011,31(2):89-91.
9 Schoepfer AM, Panczak R, Zwahlen M, et al;International EEs AI Study Group. How do gastroenterologists assess overall activity of eosinophilic esophagitis in adult patients?[J]. Am J Gastroenterol,2015,110(3):402-414.
10 Grudell AB,Alexander JA,Enders FB,et al. Validation of the Mayo Dysphagia Questionnaire[J]. Dis Esophagus,2007,20(3):202-205.
11 李燕妮,曹晓沧,王邦茂.嗜酸性食管炎的最新研究进展[J].中华消化内镜杂志,2015,32(12):860-863.
12 Hirano I. Role of advanced diagnostics for eosinophilic esophagitis[J]. Dig Dis,2014,32(1-2):78-83.
13 Shah A, Kagalwalla AF, Gonsalves N, et al. Histopathologic variability in children with eosinophilic esophagitis[J]. Am J Gastroenterol,2009,104(3):716-721.
14 赵威,王邦茂.嗜酸性粒细胞性食管炎的食管动力异常[J].中华内科杂志,2016,55(7):555-557.
15 Furuta GT,Kagalwalla AF,Lee JJ,et al. The oesophageal string test:a novel,minimally invasive method measures mucosal inflammation in eosinophilic oesophagitis[J].Gut,2013,62(10):1395-1405.
16 李建生.嗜酸性食管炎的诊断和治疗:2013 ACG临床指南介绍[J].胃肠病学和肝病学杂志,2014,23(7):721-722.
17 Wolf WA, Jerath MR, Sperry SL, et al. Dietary elimination therapy is an effective option for adults with eosinophilic esophagitis[J]. Clin Gastroenterol Hepatol,2014,12(8):1272-1279.
2 Lynch KL, Dhalla S, Chedid V, et al. Gender is a determinative factor in the initial clinical presentation of eosinophilic esophagitis[J]. Dis Esophagus,2016,29(2):174-178.
3 Dellon ES, Liacouras CA. Advances in clinical management of eosinophilic esophagitis[J]. Gastroenterology,2014,147(6):1238-1254.
4 Dellon ES,Hirano I. Epidemiology and Natural History of Eosinophilic Esophagitis[J]. Gastroenterology,2018,154(2):319-332. e3.
5 邵洁,张自力.认识嗜酸细胞性食管炎———从基因学、免疫学到临床诊治[J].临床儿科杂志,2013,31(1):1-4.
6 Straumann A, Katzka DA. Diagnosis and Treatment of Eosinophilic Esophagitis[J]. Gastroenterology,2018,154(2):346-359.
7 黄勤,于成功,邹晓平,等.嗜酸细胞性食管炎的内镜和病理学诊断及鉴别诊断[J].中华消化内镜杂志,2011,28(12):662-663.
8 范颖楠,马洪升.嗜酸细胞性食管炎研究进展[J].国际消化病杂志,2011,31(2):89-91.
9 Schoepfer AM, Panczak R, Zwahlen M, et al;International EEs AI Study Group. How do gastroenterologists assess overall activity of eosinophilic esophagitis in adult patients?[J]. Am J Gastroenterol,2015,110(3):402-414.
10 Grudell AB,Alexander JA,Enders FB,et al. Validation of the Mayo Dysphagia Questionnaire[J]. Dis Esophagus,2007,20(3):202-205.
11 李燕妮,曹晓沧,王邦茂.嗜酸性食管炎的最新研究进展[J].中华消化内镜杂志,2015,32(12):860-863.
12 Hirano I. Role of advanced diagnostics for eosinophilic esophagitis[J]. Dig Dis,2014,32(1-2):78-83.
13 Shah A, Kagalwalla AF, Gonsalves N, et al. Histopathologic variability in children with eosinophilic esophagitis[J]. Am J Gastroenterol,2009,104(3):716-721.
14 赵威,王邦茂.嗜酸性粒细胞性食管炎的食管动力异常[J].中华内科杂志,2016,55(7):555-557.
15 Furuta GT,Kagalwalla AF,Lee JJ,et al. The oesophageal string test:a novel,minimally invasive method measures mucosal inflammation in eosinophilic oesophagitis[J].Gut,2013,62(10):1395-1405.
16 李建生.嗜酸性食管炎的诊断和治疗:2013 ACG临床指南介绍[J].胃肠病学和肝病学杂志,2014,23(7):721-722.
17 Wolf WA, Jerath MR, Sperry SL, et al. Dietary elimination therapy is an effective option for adults with eosinophilic esophagitis[J]. Clin Gastroenterol Hepatol,2014,12(8):1272-1279.