Departament of Internal Medicine, Section of Gastroenterology, Santa Fe Foundation of Bogotá (Fundación Santa Fe de Bogotá), Bogotá 220246, Colombia.
Department of Endoscopy, Caldas University, Manizales 275, Colombia.
World J Gastroenterol. 2019 Aug 28;25(32):4598-4613. doi: 10.3748/wjg.v25.i32.4598.
Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology (genetic and environmental) that affects both pediatric and adult patients. Its symptoms, which include heartburn, regurgitation, and esophageal stenosis (with dysphagia being more frequent in eosinophilic esophagitis in young adults and children), are similar to those of gastroesophageal reflux disease, causing delays in diagnosis and treatment. Although endoscopic findings such as furrows, esophageal mucosa trachealization, and whitish exudates may suggest its presence, this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia (parasitic infections, hypereosinophilic syndrome, inflammatory bowel disease, among others) for which treatment could be initiated. Currently, the 3 "D"s ("Drugs, Diet, and Dilation") are considered the fundamental components of treatment. The first 2 components, which involve the use of proton pump inhibitors, corticosteroids, immunosuppressants and empirical diets or guided food elimination based on allergy tests, are more useful in the initial phases, whereas endoscopic dilation is reserved for esophageal strictures. Herein, the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed, in addition to evidence for the various treatments.
嗜酸粒细胞性食管炎是一种多因素病因（遗传和环境）引起的免疫过敏病理学，影响小儿和成年患者。其症状包括烧心、反流和食管狭窄（在年轻成人和儿童中，嗜酸粒细胞性食管炎更常出现吞咽困难），与胃食管反流病相似，导致诊断和治疗的延误。虽然内镜下发现如皱襞、食管黏膜气管化和白色渗出物可能提示其存在，但应根据每高倍视野超过 15 个嗜酸性粒细胞存在且排除其他嗜酸性粒细胞增多的原因（寄生虫感染、高嗜酸性粒细胞综合征、炎症性肠病等）来进行组织学确诊，以便开始治疗。目前，“3D”（“药物、饮食和扩张”）被认为是治疗的基本组成部分。前两个组成部分，包括质子泵抑制剂、皮质类固醇、免疫抑制剂和根据过敏试验的经验性饮食或引导性食物消除，在初始阶段更有用，而内镜扩张则保留用于食管狭窄。本文将回顾嗜酸粒细胞性食管炎的病理生理学的最重要方面，以及各种治疗方法的证据。
