嗜酸细胞性食管炎的发病机制、诊断和治疗

Pathogenesis,diagnosis,and treatment of eosinophilic esophagitis

嗜酸细胞性食管炎(简称EE)是一种慢性嗜酸细胞炎症性食管疾病,与变态反应紊乱关系密切,易与胃食管返流病(GERD)相混淆。EE可发生于各个年龄段,尤其是儿童,主要影响男性,临床症状主要有呕吐、生长停滞和体重不增、胃灼热、胸痛、上腹部疼痛、吞咽困难、食物嵌塞感。EE诊断取决于食管内镜活检结果,强调从食管远侧端、中段和近侧端等多个部位取多块活检标本。治疗结束后复查食管内镜和活检标本。当前,EE的治疗方法主要包括饮食调整、吞服丙酸氟替卡松、雾化吸入布地奈德等。

Eosinophilic esophagitis （EE） is a chronic inflammatory disease of esophagus caused by eosinophil infiltration. It is partially attributed to allergy. Clinical symptoms are often similar to gastroesophageal reflux disease （GERD）. EE can affect all age groups from infants, children to adult. However, it is more common in children. Patients with EE are predominantly males. The common symptoms include vomiting, failure to thrive, low weight gain in children, and dysphagia, heartburn, chest pain, epigastric pain in adult. Severe cases may present with food impaction and esopha- gus obstruction. The diagnosis is confirmed by the presence of eosinophils in esophageal mucosa via biopsies. Biopsies taken from multiple locations including the distant end, the midpiece and the proximal end in the esophageal mucosa are essential for the diagnosis of EE. The progress is monitored by follow-up endoscopy and esophageal mucosa biopsies after treatment. Currently, therapeutic options for the management of EE include dietary manipulation, swallowed fluticasone and nebulizer inhaled budesonide.