亚洲嗜酸性食管炎：独特的临床表型及对长期管理的意义

文献信息

中文摘要

背景： 嗜酸性食管炎（EoE）传统上被视为一种慢性、进展性炎症性疾病，与吞咽困难、食物嵌顿和纤维狭窄性重塑相关。然而，来自亚洲的日益增多的证据提示，亚洲人群中的EoE可能表现出与西方队列不同的流行病学和临床特征。结果：亚洲近期研究报告了较低的纤维狭窄并发症发生率、对质子泵抑制剂和钾竞争性酸阻滞剂更高的应答率，以及在常规筛查内镜检查中发现的无症状食管嗜酸性粒细胞增多症的高患病率。纵向研究提示，许多亚洲患者表现为相对轻微的炎症性疾病且进展有限，而严重的纤维狭窄并发症似乎不常见。尽管存在这些表型差异，分子研究表明EoE的基本生物学在不同地理区域之间基本保守。这些发现提示，亚洲和西方的EoE可能代表同一种潜在的免疫介导疾病，所观察到的临床差异可能反映了诊断时疾病分期、诊断时机、医疗体系、环境暴露和筛查实践的差异。来自亚洲的新兴数据也可能挑战所有EoE患者都不可避免地需要普遍终身维持治疗的假设。当前的维持治疗范式主要建立在富含纤维狭窄性疾病和症状驱动诊断的西方队列基础上，这可能无法完全代表亚洲日益被认识的更广泛EoE谱系。结论：在本综述中，我们总结了关于EoE地理变异的当前证据，并讨论了亚洲疾病表型对个体化长期管理策略的潜在意义。

英文摘要

Eosinophilic esophagitis (EoE) has traditionally been regarded as a chronic, progressive inflammatory disorder associated with dysphagia, food impaction, and fibrostenotic remodeling. However, growing evidence from Asia suggests that EoE in Asian populations may exhibit distinct epidemiologic and clinical characteristics from those in Western cohorts. Recent studies from Asia have reported lower rates of fibrostenotic complications, greater responsiveness to proton pump inhibitors and potassium-competitive acid blockers, and a high prevalence of asymptomatic esophageal eosinophilia detected during routine screening endoscopy. Longitudinal studies have suggested that many Asian patients exhibit relatively mild inflammatory disease with limited progression, whereas severe fibrostenotic complications appear uncommon. Despite these phenotypic differences, molecular studies have indicated that the fundamental biology of EoE is largely conserved across geographic regions. These findings suggest that Asian and Western EoE likely represent the same underlying immune-mediated disease, with observed clinical differences potentially reflecting variation in disease stage at diagnosis, timing of diagnosis, healthcare systems, environmental exposures, and screening practices. Emerging data from Asia may also challenge the assumption that all patients with EoE inevitably require universal lifelong maintenance therapy. Current maintenance paradigms have largely been established from Western cohorts enriched for fibrostenotic disease and symptom-driven diagnosis, which may not fully represent the broader spectrum of EoE increasingly recognized in Asia. In this review, we summarize current evidence regarding geographic variation in EoE and discuss the potential implications of Asian disease phenotypes for individualized long-term management strategies.