Slovenska priporočila za obravnavo odraslih bolnikov z eozinofilnim ezofagitisom

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammation of the entire esophageal wall that causes dysphagia and food impaction in adult patients, feeding problems, upper abdominal and sternal pain with associated vomiting in children. The diagnosis is made on the basis of histological analysis of biopsies of the esophageal mucosa (at least 6 biopsies) and evidence of eosinophilic inflammation with ≥15 eosinophilic granulocytes per high-magnification field or with evidence of >60 eosinophilic granulocytes/mm2 and the absence of other diseases associated with eosinophilic inflammation of the esophagus. Eosinophilic esophagitis represents a Th2 immune response to food allergens in genetically predisposed patients. It is estimated that the disease is present in 1/2000 inhabitants. Patients often have associated other allergic diseases such as asthma, allergic rhinitis, eczema, atopic dermatitis. Untreated disease can lead to stenotic changes of the entire esophageal wall. The clinical picture of adults is dominated by symptoms of dysphagia, food impaction, or retrosternal pain. Between 7%–17% of patients with proven EoE have a normal endoscopic picture of the esophagus. Other patients have signs of longitudinal furrows, rings (trachealization of the esophagus), whitish exudates, mucosal edema and/or a narrowed esophagus or esophageal strictures. There are three possible forms of treatment: elimination diets, treatment with proton pump inhibitors, or treatment with topical corticosteroids. The success of the treatment is assessed by endoscopy and 6 biopsies of the esophagus 3 months after the initiation of treatment. When the patient achieves histological and clinical remission, it is necessary to continue the treatment permanently. In maintenance treatment, we usually use half doses of drugs used for successful inicial treatment or elimination diet. If the fibrostenotic form of the disease occurs (long-term undiagnosed disease without treatment), endoscopic dilatation of the esophagus is necessary.