Esofagitis eosinofílica: diagnóstico y manejo

Abstract

Diagnosis and management of eosinophilic esophagitis Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease, induced by food allergens, clinically characterized by symptoms of esophageal dysfunction. Pathologically there is a predominant eosinophilic inflammation. This disease is relatively new, and its definitions have evolved over time. Its prevalence and incidence are increasing and causes clinical problems both in children and adults. Its symptoms include food impaction, dysphagia, symptoms that resemble gastroesophageal reflux, abdominal pain, and vomiting. It can also have extra-digestive symptoms such as rhinosinusitis, chronic cough, recurrent croup and hoarseness. EoE can be associated with other atopic conditions, such as asthma, eczema and food allergies. The diagnosis is made by the analysis of endoscopic biopsies (> 15 eosinophils per high power field). Proton pump inhibitors (PPIs) are currently accepted as a treatment for EoE. The clinical and pathological improvement with the use PPIs ceased to be a criterion to define Esophageal eosinophilia responsive to PPIs as a differential diagnosis, since this condition is currently considered within the EoE spectrum. There are three main treatment approaches for EoE: diet, drugs and dilation. Its diagnosis and early treatment are key to avoid or delay its complications, such as stenosis and severe esophageal dysfunction.

Esofagitis eosinofílica: principal causa de disfagia en niños y adultos jóvenes

“…Se ha observado un aumento en la incidencia y prevalencia de la EEo en los últimos años, principalmente en los países occidentales, en donde se estima una prevalencia de 0,5-1 por cada 1.000 habitantes. En cuanto a su incidencia, se ha observado que el 2-7% de los adultos sometidos a endoscopía digestiva alta (EDA) cumplen criterios de EEo; esto aumenta a 10-22% si la disfagia es la indicación de la EDA, y hasta 50% en casos de impactación alimentaria (10,11). La EEo se ha descrito en personas de cualquier edad, sin embargo, presenta un comportamiento bimodal que afecta habitualmente a niños entre los 5 y 9 años y adultos entre los 30 y 50 años (3,5,6).…”

Esofagite eosinofílica: uma condição inflamatória crônica do esôfago

“…O tratamento é realizado por meio de 3 itens: droga, dilatação e dieta. Inicialmente é usado um Inibidor de Bomba de Prótons (IBP), agente inflamatório e/ou dieta de eliminação, ou seja, o tratamento consiste em um acompanhamento multidisciplinar por imunologia, gastroenterologia e nutrição (BALLART MJ et al, 2020).…”

Diagnosing eosinophilic esophagitis

“…To the Editor, We recently read this interesting article in the journal: Esofagitis eosinofílica: diagnóstico y manejo 1 . After its description, eosinophilic esophagitis (EoE) has become an epidemiological and editorial phenomenon 2 .…”

“…Other aspects, such as endoscopic findings and atopic comorbidities increase the diagnostic suspicion, but they are not essential and may be absent. In theTop of Form article published 1 , the diseases that cause or may contribute to esophageal eosinophilia are listed, and it is stated that according to the 2013 guidelines, these should be excluded. However, in the 2018 consensus, in addition to including PPI-responsive esophageal eosinophilia within the spectrum of EoE, it is stated that the diseases listed as conditions associated with esophageal eosinophilia should be evaluated rather than require their exclusion, since they can coexist in some cases, such as gastroesophageal reflux disease (GERD), which is one of the most complex differential diagnoses 3 .…”