Louis-Auguste John Richard, Hoare Jonathan
Department of Gastroenterology, St Mary's Hospital, London, UK.
Frontline Gastroenterol. 2013 Apr;4(2):91-95. doi: 10.1136/flgastro-2012-100238. Epub 2012 Nov 12.
Eosinophilic oesophagitis (EO) is now established as an important cause of oesophageal symptoms. It is presumed to result from eosinophilic activation to dietary antigens, which is limited to the oesophagus. Inflammatory strictures and secondary dysmotility are common and contribute to symptomatology. Current management involves food exclusion diets and swallowed topical steroid. Strictures may require endoscopic dilatation. Relapse is common but strategies for maintaining remission are not well described. Here we describe a patient with severe stricturing EO, whose symptoms were significantly exacerbated by secondary oesophageal spasm. His symptoms were refractory to dietary, endoscopic and medical therapy including parenteral corticosteroid but responded dramatically to diltiazem. Remission was eventually achieved and maintained with azathioprine, and he was able to discontinue the other therapies and relax his dietary restrictions. We discuss the evidence for dietetic, endoscopic and pharmacological interventions for this disease.
嗜酸性粒细胞性食管炎（EO）现已被确认为食管症状的重要病因。据推测，它是由对饮食抗原的嗜酸性粒细胞激活引起的，且这种激活仅限于食管。炎症性狭窄和继发性运动障碍很常见，并导致症状出现。目前的治疗方法包括食物排除饮食和吞咽局部类固醇。狭窄可能需要内镜扩张。复发很常见，但维持缓解的策略尚无详细描述。在此，我们描述一名患有严重狭窄性EO的患者，其症状因继发性食管痉挛而显著加重。他的症状对饮食、内镜和药物治疗（包括胃肠外皮质类固醇）均无反应，但对维拉帕米反应显著。最终通过硫唑嘌呤实现并维持了缓解，他能够停止其他治疗并放宽饮食限制。我们讨论了针对这种疾病的饮食、内镜和药物干预的证据。
