Department of Medicine, The University of Western Ontario and London Health Sciences Centre, London, ON, Canada.
J Clin Gastroenterol. 2013 Aug;47(7):570-7. doi: 10.1097/MCG.0b013e318288a3c2.
Eosinophilic esophagitis (EoE), typically a pediatric disease, is becoming more frequently recognized in adults. The optimal treatment of EoE in this population has not yet been established. This paper reviews the literature detailing the treatments for EoE in adults, and provides a treatment strategy. To accomplish this task a comprehensive literature search of Medline was undertaken for studies evaluating the treatment of EoE in adults. High-dose topical corticosteroids and specific elimination diets have been found to improve symptoms, reduce eosinophilic infiltrate in esophageal mucosa, and improve endoscopic markers of inflammation. Dilation therapy does improve symptoms but not underlying inflammation. Other treatments including leukotriene inhibitors and immunomodulatory drugs have been unsuccessful. An effective strategy for treating EoE in adults is using topical corticosteroids and elimination diets for inflammatory disease, and esophageal dilation for fibrotic disease. The conclusion that inflammatory and fibrotic components of EoE respond to different treatment modalities should be evaluated in future clinical trials.
嗜酸性食管炎（EoE）通常是一种儿科疾病，但在成年人中越来越常见。目前尚未确定该人群中 EoE 的最佳治疗方法。本文综述了详细描述成人 EoE 治疗的文献，并提供了一种治疗策略。为了完成这项任务，我们对评估成人 EoE 治疗的 Medline 文献进行了全面检索。高剂量局部皮质类固醇和特定的消除饮食已被发现可改善症状、减少食管黏膜中的嗜酸性粒细胞浸润，并改善炎症的内镜标志物。扩张疗法确实可以改善症状，但不能改善潜在的炎症。其他治疗方法，包括白三烯抑制剂和免疫调节药物，均未成功。治疗成人 EoE 的有效策略是使用局部皮质类固醇和消除饮食治疗炎症性疾病，以及食管扩张治疗纤维性疾病。未来的临床试验应评估 EoE 的炎症和纤维性成分对不同治疗方式的反应。
