MEDIX, God. 27 Br. 149  •  Pregledni članak HR ENG

Eozinofilni ezofagitisEosinophilic esophagitis

Mirjana Kalauz

Eozinofilni ezofagitis (EoE) kronični je upalni poremećaj definiran simptomima disfunkcije jednjaka i eozinofilnom infiltracijom sluznice jednjaka, a bez sigurnih znakova nekoga drugog uzroka eozinofilije. Radi se o imunosno posredovanom poremećaju pri čemu hrana ili neki drugi alergeni dovode do imunosne reakcije posredovane Th2 stanicama. S obzirom na to da se radi o važnom entitetu koji uzrokuje bolesti gastrointestinalnoga sustava te recentan porast incidencije i prevalencije, izaziva znatnu pozornost medicinske i znanstvene zajednice. Klinička prezentacija uključuje disfagiju, impakciju hrane, povraćanje i refluksne simptome. Dijagnoza se postavlja na temelju kliničke slike koja upućuje na disfunkciju jednjaka, karakterističnih endoskopskih značajki bolesti i histologije koja pokazuje eozinofilnu infiltraciju nakon empirijske terapije inhibitorima protonske crpke i isključivanja drugoga poremećaja koji bi mogao biti uzrok eozinofilije. Osobito je kompleksan odnos EoE-a i GERB-a, a njihovo razlikovanje u kliničkoj praksi i dalje je izazov. Temelj terapije su dijetne modifikacije, topički steroidi i endoskopska dilatacija. Važnu ulogu u unaprjeđenju pristupa tim bolesnicima imaju liječnici obiteljske medicine s obzirom na to da je važno rano otkrivanje, ali isto tako sudjelovanje pri terapijskim odlukama i praćenju.

Ključne riječi:
dilatacija jednjaka; eozinofilni ezofagitis; GERB; inhibitori protonske crpke; topički steroidi

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 27 Br. 149

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder defined by symptoms of esophageal dysfunction and eosinophilic infiltration of the esophageal mucosa, without sure signs of any other cause of eosinophilia. It is an immune-mediated disorder in which food or other allergens cause a Th2-cell-mediated immune response. Given that it is an important entity that causes significant morbidity of the gastrointestinal tract and the recent increase in incidence and prevalence, it is attracting considerable attention from the medical and scientific community. Clinical presentation includes dysphagia, food impaction, vomiting, and reflux symptoms. The diagnosis is made on the basis of a clinical presentation suggestive of esophageal dysfunction, characteristic endoscopic features of the disease, and histology showing eosinophilic infiltration after empirical IPP therapy and exclusion of another disorder that could be the cause of eosinophilia. The relationship between EoE and GERB is particularly complex, and their differentiation in clinical practice remains a challenge. The basis of therapy are dietary modifications, topical steroids and endoscopic dilatation. Family physicians play an important role in improving access to these patients, as early detection is important, but so is participation in therapeutic decisions and follow-up. This article provides an overview of current knowledge about epidemiology, genetics, pathogenesis, clinical presentation, attitude towards GERD, diagnostic approach and therapeutic possibilities of this disorder.

Key words:
eosinophilic esophagitis; esophageal dilation; GERD; proton pump inhibitors; topical corticosteroids