嗜酸性粒细胞性食管炎与质子泵抑制剂反应性食管嗜酸性粒细胞增多单中心体验

IF 0.3 Q4 ALLERGY Astim Allerji Immunoloji Pub Date : 2019-04-21 DOI:10.21911/AAI.412
Elif Sağ, S. Mungan, F. Orhan, M. Çakır
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引用次数: 1

摘要

目的:嗜酸性食管炎是一种以嗜酸性粒细胞浸润和食管功能障碍症状为特征的慢性炎症性疾病。质子泵抑制剂反应性食管嗜酸性粒细胞增多症在临床、实验室、基因表达谱、内镜和组织病理学特征方面与嗜酸性食管炎相似。在这项研究中,我们旨在分享嗜酸性食管炎和质子泵抑制剂反应性食管嗜酸性粒细胞增多症患者的人口学特征、临床、实验室和组织病理学结果以及治疗结果。材料和方法:回顾性记录自2010年1月以来在我们诊所随访的患者的人口学特征、实验室、内镜和组织病理学表现以及治疗结果。结果:自2010年以来,我们诊所共有四千六百五十五名患者接受了食管胃镜检查,其中0.4%(n=18)的患者被诊断为嗜酸性食管炎,0.2%(n=8)的患者诊断为质子泵抑制剂反应性食管嗜酸性粒细胞增多症。嗜酸性食管炎患者的主要症状是食物嵌塞/吞咽困难(n=5,27.8%)和慢性腹痛(n=5和27.8%),其中14例(77.8%)出现过敏原致敏,12例(66.7%)出现IgE升高,12例出现外周嗜酸性粒细胞增多(6.67%),10例(55.6%)出现食物过敏原致过敏。在组织病理学检查中,平均上皮内嗜酸性粒细胞计数为48.9±30.9个细胞/HPF(400x)。当比较嗜酸性食管炎(第1组)和质子泵抑制剂反应性食管嗜酸性粒细胞增多症(第2组)患者时,发现慢性腹痛在质子泵抑制剂响应性食管嗜酸粒细胞增多组更常见,而食物过敏原致敏在嗜酸粒性食管炎组更常见(p<0.05),嗜酸性食管炎组外周嗜酸性粒细胞计数和上皮内嗜酸性粒细胞核计数较高,但差异无统计学意义。嗜酸性食管炎组采用饮食(n=11)、药物(n=17)和扩张(n=1)治疗。在两名接受TED并开始SED的患者的组织病理学检查中检测到纤维化。长期来看,任何一组均未发现副作用。结论:嗜酸性食管炎和质子泵抑制剂反应性食管嗜酸性粒细胞增多症具有相似的实验室和组织病理学特征,但在食物过敏的情况下,应更频繁地怀疑嗜酸性食道炎。嗜酸性食管炎患者必须进行长期随访。
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Eosinophilic Esophagitis and Proton Pump Inhibitor-Responsive Esophageal Eosinophilia; Single Center Experience
Objective: Eosinophilic esophagitis is a chronic inflammatory disease characterized by eosinophilic infiltration and esophagus dysfunction symptoms. Proton pump inhibitor responsive esophageal eosinophilia is similar to eosinophilic esophagitis in terms of clinical, laboratory, genetic expression profile, endoscopic and histopathological features. In this study, we aimed to share demographic features, clinical, laboratory and histopathological findings, and treatment outcomes of patient with eosinophilic esophagitis and proton pump inhibitor responsive esophageal eosinophilia. Materials and Methods: Demographic features, laboratory, endoscopic and histopathological findings, and treatment outcomes of patients followed in our clinic were recorded retrospectively since January 2010. Results: Four thousand six hundred fifty five patients underwent esophagogastroscopy since 2010 in our clinic and 0.4% (n=18) of these patients were diagnosed with eosinophilic esophagitis, and 0.2% (n=8) with proton pump inhibitor-responsive esophageal eosinophilia. The main symptom of patients with eosinophilic esophagitis were food impaction/dysphagia (n=5, 27.8%) and chronic abdominal pain (n=5, 27.8%). Allergen sensitization was found in 14 (77.8%), increased IgE in 12 (66.7%), peripheral eosinophilia in 12 (66.7%), and food allergen sensitization in 10 patients (55.6%) with eosinophilic esophagitis. On histopathological examination, the mean intraepithelial eosinophil count was 48.9 ± 30.9 cells / HPF (400x). When patients with eosinophilic esophagitis (group 1) and proton pump inhibitor-responsive esophageal eosinophilia (group 2) were compared, it was found that chronic abdominal pain was more common in the proton pump inhibitor-responsive esophageal eosinophilia group and food allergen sensitization in the eosinophilic esophagitis group (p<0.05). Total IgE, peripheral eosinophil count and intraepithelial eosinophil count were higher in the eosinophilic esophagitis group, but the differences were not statistically significant. Diet (n=11), medical (n=17) and dilatation (n=1) therapies were used in the eosinophilic esophagitis group. Fibrosis was detected on the histopathological examination in two patients who underwent TED and then SED was started. No side effect was seen any group in long term. Conclusion: Eosinophilic esophagitis and proton pump inhibitor-responsive esophageal eosinophilia have similar laboratory and histopathological features but eosinophilic esophagitis should be suspected more frequently in the presence of food allergy. Long-term followup is essential in patients with eosinophilic esophagitis.
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来源期刊
CiteScore
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期刊介绍: Asthma Allergy Immunology has been published three times a year in April, August and December as the official and periodical journal of the Turkish National Society of Allergy and Clinical Immunology since 2003. All articles published in the journal have been available online since 2003. A peer reviewed system is used in evaluation of the manuscripts submitted to Asthma Allergy Immunology. The official language of the journal is English. The aim of the journal is to present advances in the field of allergic diseases and clinical immunology to the readers. In accordance with this goal, manuscripts in the format of original research, review, case report, articles about clinical and practical applications and editorials, short report and letters to the editor about allergic diseases and clinical immunology are published in the journal. The target reader population of the Asthma Allergy Immunology includes specialists and residents of allergy and clinical immunology, pulmonology, internal medicine, pediatrics, dermatology and otolaryngology as well as physicians working in other fields of medicine interested in allergy and immunological diseases.
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