Chehade Mirna, Sher Ellen
Allergy Asthma Proc. 2017 May 1;38(3):170-176. doi: 10.2500/aap.2017.38.4036.
Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease characterized by esophageal symptoms and esophageal eosinophilia. It is induced by food triggers and by environmental allergens in some patients. No U.S. Food and Drug Administration approved therapies exist for patients with EoE. Common therapies include topical corticosteroids (TCS) and dietary restriction.
This article reviewed the pros and cons of a medical versus dietary approach in treating EoE in children and adults. Available data on short- and long-term efficacy, ease of implementation, cost, adverse effects, and quality of life (QoL) were summarized.
Although no comparative studies of TCS versus dietary restrictions exist, they seemed to be equivalent from an efficacy standpoint. However, each therapy offers different advantages and disadvantages. TCS allow ingestion of multiple food triggers and improve QoL of patients with EoE. However, TCS have the potential for topical and/or systemic adverse effects and can be costly in the long run. Dietary restriction therapies allow identification of food triggers and are less costly in the long run. However, they are more challenging to implement because they require a team approach with a dietitian and an allergist. In addition, they decrease the QoL of some children with EoE, often require extensive allergy testing and multiple endoscopies, and are not effective when environmental allergens trigger EoE. Therefore, the choice of medical versus dietary therapy needs to be individualized based on a thorough medical evaluation and discussion with patients with EoE and their families.
Research is needed to establish the lowest most effective and safe dose of TCS and the extent of adherence needed when eliminating foods for EoE, and to find less-invasive ways to monitor histologic disease activity. Potential results from this research may allow more tailored therapies or specific combination therapies that would take advantage of each treatment modality to maximize benefits to the patient while maintaining disease remission.
嗜酸性粒细胞性食管炎（EoE）是一种慢性免疫介导的食管疾病，其特征为食管症状和食管嗜酸性粒细胞增多。在一些患者中，它由食物诱因和环境过敏原诱发。美国食品药品监督管理局尚未批准用于EoE患者的治疗方法。常用治疗方法包括局部用皮质类固醇（TCS）和饮食限制。
本文综述了药物治疗与饮食治疗在儿童和成人EoE治疗中的利弊。总结了关于短期和长期疗效、实施难易程度、成本、不良反应及生活质量（QoL）的现有数据。
虽然尚无TCS与饮食限制的对比研究，但从疗效角度看它们似乎相当。然而，每种治疗方法都有不同的优缺点。TCS允许摄入多种食物诱因并改善EoE患者的生活质量。然而，TCS有局部和/或全身不良反应的风险，且从长远来看成本较高。饮食限制疗法可确定食物诱因，从长远来看成本较低。然而，它们实施起来更具挑战性，因为需要营养师和过敏症专科医生的团队协作。此外，它们会降低一些EoE儿童的生活质量，通常需要进行广泛的过敏检测和多次内镜检查，并且在环境过敏原引发EoE时无效。因此，药物治疗与饮食治疗的选择需要基于对EoE患者及其家属的全面医学评估和讨论进行个体化决策。
需要开展研究以确定TCS的最低有效安全剂量以及EoE患者在排除食物时所需的依从程度，并找到侵入性较小的方法来监测组织学疾病活动。这项研究的潜在结果可能会带来更具针对性的治疗方法或特定的联合治疗方法，这些方法将利用每种治疗方式的优势，在维持疾病缓解的同时使患者受益最大化。
