全国真实世界队列中嗜酸性食管炎与炎症性肠病重叠患者的临床特征

文献信息

中文摘要

背景： 嗜酸性食管炎（EoE）与炎症性肠病（IBD）是免疫介导的胃肠道疾病，二者之间存在已被认识的流行病学关联，但重叠疾病的临床表型仍未得到充分描述。方法：我们开展了一项回顾性队列研究，使用All of Us研究计划受控层级数据集，并映射至观察性医疗结果合作组织通用数据模型。通过国际疾病分类第九版（ICD-9）、国际疾病分类第十版（ICD-10）以及医学系统命名法临床术语（SNOMED CT）编码识别成人EoE患者，要求至少有2个不同的诊断日期。通过克罗恩病（CD）和溃疡性结肠炎（UC）诊断识别IBD重叠。分析评估了疾病顺序、特应性合并症、药物暴露、症状负担和纤维狭窄性并发症。结果：在797例符合EoE标准的患者中，28例（3.5%）存在重叠IBD（13例CD，17例UC），相对于All of Us总体队列（1.1%）富集3.2倍。重叠患者的哮喘（57.1% vs 36.8%；OR 2.29，P = 0.045）和过敏性鼻炎（71.4% vs 48.5%；OR 2.65，P = 0.020）发生率更高。皮质类固醇暴露显著更多，包括全身性（96.4% vs 66.1%；OR 13.8，P < 0.001）和局部皮质类固醇（75.0% vs 48.1%；OR 3.23，P = 0.006）。疾病顺序呈双向性，53.6%为IBD先于EoE，42.9%为EoE先于IBD。尽管治疗暴露更多，重叠患者的吞咽困难、食物嵌塞、狭窄和食管扩张发生率相似。结论：EoE与IBD重叠患者表现出一种独特表型，其特征为特应性合并症增加，但纤维狭窄性严重程度并未增加。双向的时间关系支持共同免疫易感性，而非单向疾病进展。

英文摘要

Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are immune-mediated gastrointestinal disorders with a recognized epidemiologic association, yet the clinical phenotype of overlapping disease remains incompletely characterized. We performed a retrospective cohort study using the All of Us Research Program Controlled Tier dataset mapped to the Observational Medical Outcomes Partnership common data model. Adults with EoE were identified using International Classification of Diseases, Ninth Revision (ICD-9), International Classification of Diseases, Tenth Revision (ICD-10), and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes requiring ≥2 distinct diagnosis dates. IBD overlap was identified using Crohn's disease (CD) and ulcerative colitis (UC) diagnoses. Analyses evaluated disease sequence, atopic comorbidities, medication exposure, symptom burden, and fibrostenotic complications. Among 797 patients meeting EoE criteria, 28 (3.5%) had overlapping IBD (13 CD, 17 UC), representing a 3.2-fold enrichment over the general All of Us cohort (1.1%). Overlap patients had higher rates of asthma (57.1% vs 36.8%; OR 2.29, P = 0.045) and allergic rhinitis (71.4% vs 48.5%; OR 2.65, P = 0.020). Corticosteroid exposure was substantially greater, including systemic (96.4% vs 66.1%; OR 13.8, P < 0.001) and topical corticosteroids (75.0% vs 48.1%; OR 3.23, P = 0.006). Disease sequence was bidirectional, with IBD preceding EoE in 53.6% and EoE preceding IBD in 42.9%. Despite greater treatment exposure, overlap patients demonstrated similar rates of dysphagia, food impaction, stricture, and esophageal dilation. Patients with overlapping EoE and IBD demonstrate a distinct phenotype characterized by increased atopic comorbidity without increased fibrostenotic severity. The bidirectional temporal relationship supports shared immune susceptibility rather than unidirectional disease progression.