Interactions between gastro-oesophageal reflux disease and eosinophilic oesophagitis

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• 作者：Javier Molina-Infante ; MD^a ; ^{xavi_molina@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Bram D. van Rhijn ; MD ; PhD^b
• 关键词：Eosinophilic oesophagitis ; Proton pump inhibitor-responsive oesophageal eosinophilia ; GORD
• 刊名：Best Practice & Research Clinical Gastroenterology
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：29
• 期：5
• 页码：749-758
• 全文大小：485 K

文摘

Gastro-oesophageal reflux disease (GORD) is the most common oesophageal disorder, whereas eosinophilic oesophagitis (EoE) is an emerging disease unresponsive to PPI therapy. Updated guidelines in 2011 described proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), a novel phenotype in EoE patients who were responsive to PPIs. This article aims to update the complex interplay between GORD, EoE and PPIs. Oesophageal mucosal integrity is diffusely impaired in EoE and PPI-REE patients. PPI-REE might occur with either normal or pathological pH monitoring. The genetic hallmark of EoE is overlapped in PPI-REE, but not in GORD. PPIs can partially restore epithelial integrity and reverse allergic inflammation gene expression in PPI-REE. Acid hypersensitivity in EoE patients may explain symptomatic but not histological response on PPIs. Unsolved issues with PPI-REE are whether oesophageal barrier impairment is the cause or the effect of oesophageal eosinophilia and whether PPIs primarily targets barrier integrity or oesophageal inflammation.