Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, USA.
Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
Clin Transl Gastroenterol. 2018 Dec;9(12):e212. doi: 10.1038/s41424-018-0074-8.
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus, which requires short- and long-term treatment. In addition, patients under long-term treatment for any chronic condition should have a structured follow-up. The mainstays in EoE treatment are drugs (such as swallowed topical corticosteroids [STC] and proton pump inhibitors), dietary exclusions, and endoscopic dilations. STC are the most widely used treatment and have proven efficacy in inducing clinical, endoscopic and histological remission in active EoE. However, data regarding maintaining disease remission and long-term management are limited. Ongoing disease activity and relapses despite STC treatment are frequently observed. This sheds light on the urgent need for adequate maintenance strategies, which have not been well defined. In terms of follow-up concepts, to date neither guidelines nor consensus recommendations have been published. To summarize the current knowledge on long-term diagnostic and therapeutic STC management of EoE, we conducted a literature search using PubMed and Embase applying the following key search items: Eosinophilic esophagitis, eosinophils, esophagus, swallowed topical corticosteroids, fluticasone, budesonide, long-term, treatment, therapy, and follow-up. In addition, we present empirically developed long-term management concepts applied at two large EoE centers, with a special focus on STC treatments. Finally, we highlight areas of future research and perspectives regarding the long-term management of EoE.
嗜酸粒细胞性食管炎（EoE）是一种慢性食管炎症，需要短期和长期治疗。此外，任何慢性疾病的长期治疗患者都应进行结构化随访。EoE 治疗的主要方法是药物（如口服局部皮质类固醇[STC]和质子泵抑制剂）、饮食排除和内镜扩张。STC 是应用最广泛的治疗方法，已被证明可有效诱导活动期 EoE 的临床、内镜和组织学缓解。然而，关于维持疾病缓解和长期管理的数据有限。尽管进行了 STC 治疗，但仍经常观察到疾病持续活动和复发。这凸显了迫切需要适当的维持策略，但目前尚未明确。在随访概念方面，迄今为止，既没有指南也没有共识建议被发表。为了总结 EoE 的长期诊断和治疗性 STC 管理的现有知识，我们使用 PubMed 和 Embase 进行了文献检索，应用了以下关键搜索项：嗜酸粒细胞性食管炎、嗜酸性粒细胞、食管、口服局部皮质类固醇、氟替卡松、布地奈德、长期、治疗、疗法和随访。此外，我们还介绍了在两个大型 EoE 中心应用的经验性开发的长期管理概念，特别关注 STC 治疗。最后，我们强调了 EoE 长期管理方面的未来研究和前景领域。
