Mayssan Muftah, Kenneth Barshop, Walker D Redd, Alison H Goldin, Wai-Kit Lo, Walter W Chan
{"title":"基线外周嗜酸性粒细胞计数可独立预测嗜酸性粒细胞食管炎患者对质子泵抑制剂的反应","authors":"Mayssan Muftah, Kenneth Barshop, Walker D Redd, Alison H Goldin, Wai-Kit Lo, Walter W Chan","doi":"10.1097/MCG.0000000000001845","DOIUrl":null,"url":null,"abstract":"<p><strong>Goals: </strong>To assess the predictive value of baseline peripheral absolute eosinophil counts (AECs) for proton pump inhibitor (PPI) response in eosinophilic esophagitis (EoE).</p><p><strong>Background: </strong>PPI leads to histologic remission in ~50% of EoE patients, although there are few distinguishing clinical features between PPI-responsive (PPI-r-EoE) and nonresponsive (PPI-nr-EoE) diseases. Peripheral eosinophilia is present in ~50% of EoE cases and is associated with eosinophil density on esophageal biopsy and worse clinical outcomes. The association between peripheral eosinophilia and PPI-responsiveness in EoE remains unclear.</p><p><strong>Study: </strong>This is a retrospective cohort study of adult EoE patients at a tertiary center between 2012 and 2016. All patients underwent twice daily PPI trials for ≥8 weeks followed by repeat esophageal biopsies and were classified as PPI-r-EoE or PPI-nr-EoE based on histologic response (<15 eosinophils/high power field). Baseline peripheral AEC was obtained within 1 month before index endoscopy. Analyses were performed using Fisher exact/Student t test (univariate) and logistic regression (multivariable).</p><p><strong>Results: </strong>One hundred eighty-three patients (91 PPI-nr-EoE and 92 PPI-r-EoE) were included. Mean peripheral AEC was higher among PPI-nr-EoE patients (0.41 vs 0.24 K/µL, P = 0.013). Baseline peripheral eosinophilia (>0.5 K/µL) was more prevalent among patients with PPI-nr-EoE (70.4% vs 45.5%, P = 0.023) and a history of food impaction (51.9% vs 23.7%, P = 0.0082). On multivariable analyses, peripheral eosinophilia remained an independent predictor for PPI response (adjacent odds ratio = 2.86, CI: 1.07-7.62, P = 0.036) and food impaction (adjacent odds ratio = 2.80, CI: 1.07-7.35, P = 0.037).</p><p><strong>Conclusions: </strong>Baseline peripheral eosinophilia independently predicts PPI nonresponse and food impaction in EoE patients. Peripheral AEC may help therapy selection in EoE and prevent delays in achieving histologic remission.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.8000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Baseline Peripheral Eosinophil Count Independently Predicts Proton Pump Inhibitor Response in Eosinophilic Esophagitis.\",\"authors\":\"Mayssan Muftah, Kenneth Barshop, Walker D Redd, Alison H Goldin, Wai-Kit Lo, Walter W Chan\",\"doi\":\"10.1097/MCG.0000000000001845\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Goals: </strong>To assess the predictive value of baseline peripheral absolute eosinophil counts (AECs) for proton pump inhibitor (PPI) response in eosinophilic esophagitis (EoE).</p><p><strong>Background: </strong>PPI leads to histologic remission in ~50% of EoE patients, although there are few distinguishing clinical features between PPI-responsive (PPI-r-EoE) and nonresponsive (PPI-nr-EoE) diseases. Peripheral eosinophilia is present in ~50% of EoE cases and is associated with eosinophil density on esophageal biopsy and worse clinical outcomes. The association between peripheral eosinophilia and PPI-responsiveness in EoE remains unclear.</p><p><strong>Study: </strong>This is a retrospective cohort study of adult EoE patients at a tertiary center between 2012 and 2016. All patients underwent twice daily PPI trials for ≥8 weeks followed by repeat esophageal biopsies and were classified as PPI-r-EoE or PPI-nr-EoE based on histologic response (<15 eosinophils/high power field). Baseline peripheral AEC was obtained within 1 month before index endoscopy. Analyses were performed using Fisher exact/Student t test (univariate) and logistic regression (multivariable).</p><p><strong>Results: </strong>One hundred eighty-three patients (91 PPI-nr-EoE and 92 PPI-r-EoE) were included. Mean peripheral AEC was higher among PPI-nr-EoE patients (0.41 vs 0.24 K/µL, P = 0.013). Baseline peripheral eosinophilia (>0.5 K/µL) was more prevalent among patients with PPI-nr-EoE (70.4% vs 45.5%, P = 0.023) and a history of food impaction (51.9% vs 23.7%, P = 0.0082). On multivariable analyses, peripheral eosinophilia remained an independent predictor for PPI response (adjacent odds ratio = 2.86, CI: 1.07-7.62, P = 0.036) and food impaction (adjacent odds ratio = 2.80, CI: 1.07-7.35, P = 0.037).</p><p><strong>Conclusions: </strong>Baseline peripheral eosinophilia independently predicts PPI nonresponse and food impaction in EoE patients. Peripheral AEC may help therapy selection in EoE and prevent delays in achieving histologic remission.</p>\",\"PeriodicalId\":15457,\"journal\":{\"name\":\"Journal of clinical gastroenterology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of clinical gastroenterology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MCG.0000000000001845\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MCG.0000000000001845","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目标：评估基线外周绝对嗜酸性粒细胞计数（AEC）对嗜酸性粒细胞性食管炎（EoE）质子泵抑制剂（PPI）反应的预测价值：背景：质子泵抑制剂可使约 50% 的嗜酸性粒细胞食管炎患者的组织学症状得到缓解，但质子泵抑制剂反应性食管炎（PPI-r-EoE）和非反应性食管炎（PPI-nr-EoE）之间的临床特征并不明显。约 50% 的咽喉炎病例存在外周嗜酸性粒细胞增多，这与食管活检的嗜酸性粒细胞密度和较差的临床预后有关。外周嗜酸性粒细胞增多与胃食管返流性炎症的 PPI 反应性之间的关系仍不清楚：这是一项回顾性队列研究，研究对象是2012年至2016年期间在一家三级中心就诊的成年EoE患者。所有患者均接受了为期≥8周的每日两次PPI试验，随后进行了重复食管活检，并根据组织学反应分为PPI-r-EoE和PPI-nr-EoE（结果：183名患者（其中1/4为PPI-r-EoE，1/4为PPI-nr-EoE）接受了PPI-r-EoE试验：共纳入 183 例患者（91 例 PPI-nr-EoE 和 92 例 PPI-r-EoE）。PPI-nr-EoE患者的平均外周AEC更高（0.41 vs 0.24 K/µL，P = 0.013）。基线外周嗜酸性粒细胞增多（>0.5 K/µL）在PPI-nr-EoE患者（70.4% vs 45.5%，P = 0.023）和有食物嵌塞史的患者（51.9% vs 23.7%，P = 0.0082）中更为普遍。在多变量分析中，外周嗜酸性粒细胞增多仍是PPI反应（邻近几率比=2.86，CI：1.07-7.62，P=0.036）和食物嵌塞（邻近几率比=2.80，CI：1.07-7.35，P=0.037）的独立预测因素：结论：基线外周嗜酸性粒细胞增多可独立预测咽喉炎患者的 PPI 无应答和食物嵌塞。外周嗜酸性粒细胞增多症可能有助于选择治疗咽喉炎的方法，并防止延误实现组织学缓解。
Goals: To assess the predictive value of baseline peripheral absolute eosinophil counts (AECs) for proton pump inhibitor (PPI) response in eosinophilic esophagitis (EoE).
Background: PPI leads to histologic remission in ~50% of EoE patients, although there are few distinguishing clinical features between PPI-responsive (PPI-r-EoE) and nonresponsive (PPI-nr-EoE) diseases. Peripheral eosinophilia is present in ~50% of EoE cases and is associated with eosinophil density on esophageal biopsy and worse clinical outcomes. The association between peripheral eosinophilia and PPI-responsiveness in EoE remains unclear.
Study: This is a retrospective cohort study of adult EoE patients at a tertiary center between 2012 and 2016. All patients underwent twice daily PPI trials for ≥8 weeks followed by repeat esophageal biopsies and were classified as PPI-r-EoE or PPI-nr-EoE based on histologic response (<15 eosinophils/high power field). Baseline peripheral AEC was obtained within 1 month before index endoscopy. Analyses were performed using Fisher exact/Student t test (univariate) and logistic regression (multivariable).
Results: One hundred eighty-three patients (91 PPI-nr-EoE and 92 PPI-r-EoE) were included. Mean peripheral AEC was higher among PPI-nr-EoE patients (0.41 vs 0.24 K/µL, P = 0.013). Baseline peripheral eosinophilia (>0.5 K/µL) was more prevalent among patients with PPI-nr-EoE (70.4% vs 45.5%, P = 0.023) and a history of food impaction (51.9% vs 23.7%, P = 0.0082). On multivariable analyses, peripheral eosinophilia remained an independent predictor for PPI response (adjacent odds ratio = 2.86, CI: 1.07-7.62, P = 0.036) and food impaction (adjacent odds ratio = 2.80, CI: 1.07-7.35, P = 0.037).
Conclusions: Baseline peripheral eosinophilia independently predicts PPI nonresponse and food impaction in EoE patients. Peripheral AEC may help therapy selection in EoE and prevent delays in achieving histologic remission.
期刊介绍：
Journal of Clinical Gastroenterology gathers the world''s latest, most relevant clinical studies and reviews, case reports, and technical expertise in a single source. Regular features include cutting-edge, peer-reviewed articles and clinical reviews that put the latest research and development into the context of your practice. Also included are biographies, focused organ reviews, practice management, and therapeutic recommendations.
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