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Hépato-Gastro & Oncologie Digestive

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Inflammation of the upper and lower digestive tracts: common mechanisms and treatments or different pathologies? Volume 30, supplement 5, September 2023

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Tables

Authors
1 Hospices Civils de Lyon, CH Lyon-Sud, Service de gastroentérologie, 165 chemin du Grand Revoyet, 69395 Pierre Bénite
2 INSERM U1111 – Équipe APY « Autophagie-Immunité-Infection », Centre International de Recherche en Infectiologie (CIRI), Lyon
3 CHU de Toulouse, Hôpital Rangueil, Service de gastroentérologie et pancréatologie, 1 avenue Jean Poulhès, TSA 50032, 31059, Toulouse Cedex 9
* Correspondance : S. Nancey

Eosinophilic polymorphonuclear cells have an anti-infectious, antiparasitic and antibacterial effector function, and participate in the inflammatory response via the release of numerous cytotoxic mediators. Excessive release of these mediators could contribute to the pathogenesis of IBD via the tissue lesions they generate. Atopic and allergic conditions are associated with eosinophilic esophagitis and IBD. Ultra-processed food is thought to promote Crohn’s disease. Analysis of the intestinal microbiota present in the upper digestive tract is complex but may be relevant in certain clinical situations. The manipulation of fecal microbiota for therapeutic purposes remains in the realm of research. It is now clear that environmental factors occurring in the first months and years of life condition the risk of developing IBD and eosinophilic esophagitis. A key factor in reducing the risk of esophageal stenosis in eosinophilic esophagitis is early diagnosis, to avoid complications such as stenosis. Ingested topical corticosteroids (mainly budesonide 1-4 mg/d and fluticasone 800 μg-3 mg/day) are the treatment of choice for eosinophilic esophagitis. Remission is maintained under treatment at one year in 75% of patients, and a profound histological remission (absence of eosinophils in the oesophagus) at 2 years in 76 and 79% of patients under treatment at doses of 0,5 mg and 1 mg, respectively. Predictive factors for severe UC were age under 40 at diagnosis, female gender, presence of extra-intestinal manifestations, and smoking cessation. The risk of hospitalization is increased in the case of early recourse to corticosteroid therapy and extensive disease. In the case of Crohn’s disease, 22% of patients will present a mild form of the disease during their follow-up, 25% a severe form and 53% an alternating period of relapses and remissions. The clinician’s objective is to avoid “over-treatment” of mild forms, and to avoid delaying the initiation of biotherapies during severe forms. Adherence to a Mediterranean diet is associated with a lower risk of developing Crohn’s disease.