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Eosinophilic esophagitis is a chronic disease of the esophagus that develops through an immune system. It belongs to the so-called eosinophilic diseases of the gastrointestinal tract, in which there is intense infiltration of eosinophils (eosinophils) in various layers of the gastrointestinal wall, in this case the esophagus. It is progressive and, if left untreated, leads to fibrosis and strictures of the esophagus, and consequently its dysfunction.

Eosinophilic esophagitisoccurs at all ages, but is most commonly diagnosed in people aged 40-50, much more often in men. The first symptoms appear already in childhood. In people predisposed as a result of a food or inhalation allergen, a chronic inflammatory reaction develops, leading to fibrosis and disorders of the esophageal motility. IgE-dependent and cellular mechanisms as well as the chemokine secreted by eosinophils, the so-called eotaxin 3. The microscopic image shows the presence of eosinophilic infiltrates in the epithelium and other layers of the esophageal wall, eosinophil clusters (micro-abscesses), widening of the intercellular spaces, hypertrophy and elongation of the nipples of the basal layer and fibrosis of the basal layer of the mucosa.

Eosinophilic esophagitis: symptoms

Symptoms of eosinophilic esophagitis are non-specific and age dependent. In children, the most common:

  • stomach pains
  • vomiting
  • symptoms of gastroesophageal reflux disease
  • reluctance to swallow food
  • loss of appetite
  • inhibition of weight gain and growth.

In adolescents and adults it appears:

  • dysphagia
  • retrosternal pain
  • nausea
  • vomiting
  • food trapped.

It is characteristic to avoid products that cause problems with swallowing, to wash down food with plenty of fluids and to chew for a long time. Additionally, patients often suffer from atopic diseases such as asthma, allergic rhinitis, atopic dermatitis or IgE-dependent food allergies.

Eosinophilic esophagitis: diagnosis

In the diagnosis of the disease, endoscopic examination of the esophagus with the collection of specimens fromthe proximal and distal parts of its mucosa. Diagnosis is based on the finding of>15 eosinophils in the visual field in esophageal mucosa biopsies at 400x magnification. Endoscopic examination reveals single or multiple longitudinal furrows, circular folds, papules, erythema, white deposits, no vascular drawing, congestion and swelling of the mucosa, and segmental strictures of the esophagus, most often in its proximal part. The contrast test of the esophagus, similarly to endoscopy, shows a narrowing of the lumen of the esophagus, isolated esophageal strictures and single or multiple rings.

Laboratory tests show peripheral blood eosinophilia, increased total blood IgE and IgE levels specific for inhalation and food allergens.

There is no evidence of GERD in the 24-hour monitoring of intesophageal pH. Currently, empirical 6-8 weeks treatment with proton pump inhibitors 2mg / kg / 24h in two doses (maximum 40mg twice daily) prior to esophageal endoscopy and examination is recommended. histological biopsy of his mucosa. The goal of this action is to eliminate gastro-oesophageal reflux disease as the cause of the patient's symptoms.

Eosinophilic esophagitis: differentiation

The differential diagnosis takes into account:

  • gastroesophageal reflux disease
  • yeast esophagitis
  • viral esophagitis
  • bacterial esophagitis
  • eosinophilic gastroenteritis
  • food or drug allergy
  • celiakia
  • Leśniowski and Crohn's disease
  • systemic diseases of connective tissue
  • hypereosinophilic syndrome
  • Churg-Strauss syndrome
  • graft versus host disease
  • pemphigus

Eosinophilic esophagitis: treatment

Treatment is based on the use of an appropriate diet and pharmacotherapy. An elemental diet for 4 weeks is recommended, which reduces symptoms and inflammatory changes. In the nutritional recommendations, attention is paid to an attempt to identify and avoid foods that cause symptoms of the disease. The elimination of the most common allergenic foods such as cow's milk, eggs, wheat, peanuts and seafood from the diet has been shown to improve clinical and histological improvement in more than 70% of children - in adults this percentage is slightly lower.

In pharmacotherapy, glucocorticosteroids are administered locally or systemically. Topical glucocorticosteroids are the drugs of first choice - orally inhaled preparations are used,the most common is budesonide (2 mg / d) or fluticasone (880-1760 micrograms twice a day). The use of systemic corticosteroids is restricted to patients who require rapid clinical improvement due to the severity of the disease or who have not responded to other treatments. For this purpose, prednisone is used at a dose of 1-2 mg / kg / day.

Endoscopic treatment is reserved for patients with narrowing of the esophagus disrupting swallowing and when there is no improvement after standard treatment. Due to the high risk of esophageal perforation, endoscopic dilation of esophageal strictures should be performed with extreme caution.

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Category:

Gastrology