期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
卷 137, 期 1, 页码 147-+出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2015.05.045
关键词
Eosinophilic esophagitis; remodeling; fibrosis; topical corticosteroid; TGF-beta 1
资金
- National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (NIAID) [AI 092135]
- ART/APFED HOPE Award
- Department of Defense [FA100044]
- NIH/NIAID [AI 107779, AI 70535, AI 72115]
- Hearst Foundation
- CEGIRS, Rare Diseases Clinical Research Network, an initiative of the Office of Rare Diseases Research, NCATS [U54AI117804]
- NCATS
- NIAID
- NIDDK
- NIH [ULRR031980]
- CTSA [ULT1TR0001000]
Background: Eosinophilic esophagitis (EoE) is a chronic T(H)2 inflammatory disease characterized by tissue remodeling that leads to esophageal strictures and food impactions. Effects of therapy on long-term remodeling in patients with pediatric eosinophil-associated diseases have not been previously described. Objective: We sought to understand the long-term control of esophageal remodeling in patients with EoE. Methods: We assessed endoscopic and histologic remodeling and TGF-beta 1 expression in esophageal biopsy specimens from children (n = 32) with EoE treated with topical corticosteroids (TCSs) over 10 years (mean, 4.5 years). We used standardized EoE scoring tools to gauge endoscopic and symptom features. Results: Seven hundred thirty-eight biopsy specimens from 246 endoscopic procedures were evaluated over 10 years. Four hundred eighty-six biopsy specimens had adequate lamina propria for evaluation of subepithelial remodeling. The severity of epithelial esophageal eosinophilia correlated with epithelial remodeling (basal zone hyperplasia, desquamation, and dilated intercellular spaces; P < .0001), lamina propria eosinophilia (P < .0001), and fibrosis (P < .0001). Sixteen subjects were initial responders (<15 eosinophils/high-power field) to TCSs. Responders and nonresponders spent 54% and 97% of their total disease duration with active EoE (P < .001) and 23% and 53% (P < .02) with maximal fibrosis scores, respectively. Responders had lower endoscopy scores during their disease duration (P = .013). Having less than 15 eosinophils/high-power field at any time correlated with lower fibrosis and endoscopic severity. TGF-beta 1(+) cell counts decreased in responders at the first biopsy, but this was not sustained. Symptoms did not correlate with other disease features. Conclusions: Children with EoE have substantial esophageal remodeling, which associates with inflammation and can improve in a sustainable manner with TCSs. Although endoscopic features correspond to histologic features, symptoms did not correlate with inflammation or fibrosis.
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