背景:嗜酸细胞性食管炎(EoE)患者通常伴有特应性疾病,但是特应性疾病的表现或治疗反应是否存在差异尚不清楚。
目的:确定患有多种特应性疾病的EoE患者对局部皮质类固醇(tCS)治疗的表现或反应是否存在差异。
方法:我们对新诊断的EoE成人和儿童进行了回顾性队列研究。特应性合并症的总数(过敏性鼻炎,哮喘,湿疹,食物过敏)进行计算。除过敏性鼻炎外,具有≥2种特应性疾病的患者被定义为具有多种特应性疾病,并将其基线特征与具有<2种特应性疾病的患者进行比较。组织学,症状,和内镜对tCS治疗的反应也与双变量和多变量分析进行了比较.
结果:在1020例EoE特应性疾病患者中,235例(23%)有1例特应性合并症,211(21%)有2,113(11%)有3,34(3%)有4。在基线,180例(18%)≥2种特应性疾病患者年龄较小,呕吐较多,腹痛较少,更多的渗出物和水肿在内窥镜检查,和更高的嗜酸性粒细胞峰值计数。在接受tCS治疗的患者中,<2特应性疾病的患者有更好的整体症状反应的趋势,但与≥2特应性疾病患者相比,组织学或内镜反应无差异.
结论:有和没有多种特应性疾病的患者在EoE的初始表现上存在差异,但特应性状态对皮质类固醇的组织学治疗反应没有重大差异。
Patients with eosinophilic esophagitis (EoE) typically have concomitant atopic conditions, but whether there are differences in presentation or treatment response by the number of atopic diseases is unknown.
To determine whether patients with EoE having multiple atopic conditions have differences in presentation or response to topical corticosteroid (TCS) treatment.
We performed a retrospective cohort study of adults and children with newly diagnosed EoE. The total number of atopic comorbidities (allergic rhinitis, asthma, eczema, food allergy) was calculated. Patients with at least 2 atopic conditions other than allergic rhinitis were defined as having multiple atopic conditions and their baseline characteristics were compared with those with less than 2 atopic conditions. Histologic, symptom, and endoscopic responses to TCS treatment were also compared with bivariable and multivariable analyses.
Of the 1020 patients with EoE having atopic disease information, 235 (23%) had 1 atopic comorbidity, 211 (21%) had 2, 113 (11%) had 3, and 34 (3%) had 4. At baseline, the 180 (18%) patients with 2 or more atopic diseases were younger and had more vomiting, less abdominal pain, more exudates and edema on endoscopy, and higher peak eosinophil counts. Among those treated with TCS, there was a trend toward better global symptom response in patients with less than 2 atopic conditions, but there was no difference in histologic or endoscopic response compared with those with 2 or more atopic conditions.
There were differences in the initial presentation of EoE between those with and without multiple atopic conditions, but there were no major differences in histologic treatment response to corticosteroids by atopic status.