OBJECTIVES Mast cells (MCs) are increased in eosinophilic esophagitis (EoE). Endoscopic abnormalities, symptoms, and epithelial changes can persist after treatment despite a reduction of esophageal eosinophilia. It is unknown whether this could be due to persistent MC infiltration. We aimed to determine whether patients with histologically inactive (HI) EoE (defined as <15 eosinophils per high-powered field) with persistent symptoms, endoscopic, or epithelial abnormalities after treatment have increased MCs. METHODS Secondary analysis of prospective data from 93 children with EoE undergoing post-treatment endoscopy between 2011 and 2015. Thirty-five non-EoE controls were included. Immunohistochemistry for tryptase, an MC marker, was performed on mid and distal esophageal biopsies. Total and degranulated intraepithelial MCs per high-powered field (MC/hpf) were quantified. Symptoms and endoscopic findings were recorded at time of endoscopy. MC/hpf were compared between HI-EoE and control, and among HI-EoE based on endoscopic and histologic findings, and symptoms. Nine clinical remission (CR) patients were identified, with absence of endoscopic abnormalities and symptoms. RESULTS MC/hpf were increased in HI-EoE compared with control (17 ± 11 vs 8 ± 6, P < 0.0). Patients with persistent endoscopic abnormalities had increased total (20 ± 12 vs 13 ± 10, P = 0.001) and degranulated (8 ± 6 vs 5 ± 4, P = 0.002) MC/hpf, with no difference in eosinophils. MC/hpf predicted furrowing (odds ratio = 1.06, P = 0.01) and rings (odds ratio = 1.05, P = 0.03) after controlling for treatment type, proton-pump inhibitor, eosinophils, and duration of therapy. Patients with persistent basal zone hyperplasia and dilated intercellular spaces had increased MC/hpf. Eosinophils were weakly correlated with MC/hpf in the mid (r = 0.30, P < 0.001) and distal (r = 0.29, P < 0.001) esophagus. Clinical remission patients had lower MC/hpf compared with patients with persistent symptoms and/or endoscopic abnormalities. DISCUSSION MC density is increased in patients with endoscopic and epithelial abnormalities, as well as a few symptoms, despite resolution of esophageal eosinophilia after treatment. This association warrants further study to ascertain whether MCs play an eosinophil independent role in EoE.

中文翻译：

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尽管小儿嗜酸性粒细胞性食管炎中嗜酸性粒细胞增多症得到解决，但肥大细胞浸润与持续症状和内镜异常有关。

目的 嗜酸性食管炎 (EoE) 中的肥大细胞 (MC) 增加。尽管食管嗜酸性粒细胞减少，但治疗后内镜异常、症状和上皮变化仍会持续存在。目前尚不清楚这是否是由于持续的 MC 渗透。我们旨在确定治疗后具有持续症状、内窥镜或上皮异常的组织学非活动性 (HI) EoE（定义为每个高倍视野<15 个嗜酸性粒细胞）的患者是否增加了 MC。方法 对 2011 年至 2015 年间接受治疗后内镜检查的 93 名 EoE 儿童的前瞻性数据进行二次分析。纳入了 35 名非 EoE 对照。对中段和远端食管活检进行了类胰蛋白酶（一种 MC 标志物）的免疫组织化学分析。对每个高倍视野 (MC/hpf) 的总和脱粒上皮内 MC 进行量化。在内窥镜检查时记录症状和内窥镜检查结果。MC/hpf 在 HI-EoE 和对照之间进行比较，在 HI-EoE 之间根据内窥镜和组织学发现以及症状进行比较。确定了 9 名临床缓解 (CR) 患者，没有内镜检查异常和症状。结果 与对照组相比，HI-EoE 组的 MC/hpf 增加（17 ± 11 vs 8 ± 6，P < 0.0）。持续内镜检查异常的患者总 MC/hpf 增加（20 ± 12 vs 13 ± 10，P = 0.001）和脱粒（8 ± 6 vs 5 ± 4，P = 0.002）MC/hpf，嗜酸性粒细胞无差异。在控制治疗类型、质子泵抑制剂、嗜酸性粒细胞、和治疗时间。基底区持续增生和细胞间隙扩张的患者 MC/hpf 增加。嗜酸性粒细胞与中段（r = 0.30，P < 0.001）和远端（r = 0.29，P < 0.001）食管的 MC/hpf 呈弱相关。与有持续症状和/或内镜异常的患者相比，临床缓解患者的 MC/hpf 较低。讨论 尽管食管嗜酸性粒细胞增多症在治疗后消退，但内镜和上皮异常以及一些症状患者的 MC 密度增加。这种关联值得进一步研究以确定 MC 是否在 EoE 中发挥嗜酸性粒细胞独立作用。嗜酸性粒细胞与中段（r = 0.30，P < 0.001）和远端（r = 0.29，P < 0.001）食管的 MC/hpf 呈弱相关。与有持续症状和/或内镜异常的患者相比，临床缓解患者的 MC/hpf 较低。讨论 尽管食管嗜酸性粒细胞增多症在治疗后消退，但内镜和上皮异常以及一些症状患者的 MC 密度增加。这种关联值得进一步研究以确定 MC 是否在 EoE 中发挥嗜酸性粒细胞独立作用。嗜酸性粒细胞与中段（r = 0.30，P < 0.001）和远端（r = 0.29，P < 0.001）食管的 MC/hpf 呈弱相关。与有持续症状和/或内镜异常的患者相比，临床缓解患者的 MC/hpf 较低。讨论 尽管食管嗜酸性粒细胞增多症在治疗后消退，但内镜和上皮异常以及一些症状患者的 MC 密度增加。这种关联值得进一步研究以确定 MC 是否在 EoE 中发挥嗜酸性粒细胞独立作用。以及一些症状，尽管治疗后食管嗜酸性粒细胞增多症消退。这种关联值得进一步研究以确定 MC 是否在 EoE 中发挥嗜酸性粒细胞独立作用。以及一些症状，尽管治疗后食管嗜酸性粒细胞增多症消退。这种关联值得进一步研究以确定 MC 是否在 EoE 中发挥嗜酸性粒细胞独立作用。