Greuter Thomas
Service de gastro-entérologie et d'hepatologie, Centre hospitalier universitaire vaudois (CHUV), Lausanne, Schweiz.
Departement Innere Medizin, GZO Spital Wetzikon, Spitalstrasse 66, 8620, Wetzikon, Schweiz.
Inn Med (Heidelb). 2025 Feb;66(2):156-164. doi: 10.1007/s00108-024-01828-7. Epub 2025 Jan 10.
Eosinophilic esophagitis (EoE) was first described in the early 1990s. Initially a rarity, it is now the most common cause of dysphagia for solid foods in young adults. Its prevalence is estimated to be 1:2000. Mechanistically, EoE is characterized by a chronic type‑2 T‑helper cell (Th2) inflammation of the esophagus which is triggered by food allergens. It often occurs in association with other Th2-mediated diseases, such as asthma, atopic dermatitis, and chronic rhinosinusitis with nasal polyps. EoE is diagnosed based on an esophagogastroduodenoscopy with biopsies of the esophageal epithelium. The diagnosis can be established when both symptoms of esophageal dysfunction (usually dysphagia) and an eosinophilic infiltration of at least 15 eosinophils per high-power field (HPF) are present. EoE can be treated with drugs, diet, and endoscopic dilatation. In terms of diet, milk elimination appears most reasonable, particularly as first choice. Drug treatment includes proton pump inhibitors (PPI), topical steroids, and the biologic agent dupilumab. Endoscopic dilatation is effective but does not treat the underlying inflammation. Therefore, it should never be used alone, but rather as an add-on therapy. In cases where clinical suspicion of EoE is strong but no or only few eosinophils are detected in esophageal biopsies, the diagnosis of an EoE variant should be considered. This review article provides a detailed discussion of the epidemiology, clinical features, diagnosis, treatment, and variants of EoE.
嗜酸性食管炎(EoE)于20世纪90年代初首次被描述。起初较为罕见,如今它是年轻成年人固体食物吞咽困难的最常见原因。据估计其患病率为1:2000。从机制上讲,EoE的特征是食管由食物过敏原引发的慢性2型辅助性T细胞(Th2)炎症。它常与其他Th2介导的疾病相关,如哮喘、特应性皮炎和伴有鼻息肉的慢性鼻-鼻窦炎。EoE通过食管胃十二指肠镜检查及食管上皮活检来诊断。当出现食管功能障碍症状(通常为吞咽困难)且每高倍视野(HPF)至少有15个嗜酸性粒细胞的嗜酸性浸润时,即可确立诊断。EoE可通过药物、饮食和内镜扩张进行治疗。在饮食方面,消除牛奶似乎最为合理,尤其是作为首选。药物治疗包括质子泵抑制剂(PPI)、局部类固醇和生物制剂度普利尤单抗。内镜扩张有效,但不能治疗潜在炎症。因此,绝不应单独使用,而应作为辅助治疗。在临床高度怀疑EoE但食管活检中未检测到或仅检测到少量嗜酸性粒细胞的情况下,应考虑诊断为EoE变异型。这篇综述文章对EoE的流行病学、临床特征、诊断、治疗和变异型进行了详细讨论。
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