Zusammenfassung
Die eosinophile Ösophagitis wird zunehmend auch bei Erwachsenen entdeckt. Hauptsymptome sind: Dysphagie (93 %), Nahrungsbolus in der Speiseröhre (62 %), Sodbrennen (24 %). In 52 % der Patienten sind anamnestisch Allergien bekannt, in 31 % ist eine periphere eosinophile Ösophagitis nachweisbar. Ösophagusmanometrien zeigen unspezifische Molitätsstörungen in 40 % der Patienten. Endoskopische Befunde sind eine Mukosafragilität oder ein Ödem (59 %), solitäre oder multiple konzentrische Ringe (49 %), Strikturen (40 %), stecknadelkopfgroße weißliche Exsudate oder Papeln (16 %) und ein kleiner Ösophagusdurchmesser (5 %); 9 % der Patienten haben einen normalen Endoskopiebefund. Bei Erwachsenen mit eosinophiler Ösophagitis hat die Ösophagusdilatation eine begrenzte Wirkung und sie ist im Vergleich zur Dilatation von Patienten mit benignen Strikturen mit einer erhöhten Komplikationsrate behaftet. Die Gabe von inhalierbaren oder systemischen Kortiosteroiden hat in etwa 95 % der Patienten eine symptomatische Besserung zur Folge. Eine Behandlung mit Kortikoiden vor Bougierung kann die aktive Entzündung vermindern und deshalb die Komplikationsrate der Bougierung vermindern.
Abstract
Eosinophilic esophagitis is a condition that is being increasingly recognized in adults. The main presenting symptoms are dysphagia (93 %), food impaction (62 %), and heartburn (24 %). A history of allergy is obtained in 52 % of patients and peripheral eosinophilia is found in 31 % of patients with this condition. Esophageal manometric studies have provided evidence of a nonspecific motility disorder in 40 % of patients. Endoscopic findings include mucosal fragility or edema (59 %), solitary or multiple concentric rings (49 %), strictures (40 %), whitish pinpoint exudates or papules (16 %), and a small-caliber esophagus (5 %); 9 % of patients present with a normal endoscopy. Esophageal dilation in adults with eosinophilic esophagitis has limited efficacy and is associated with an increased complication rate compared with dilation in patients with benign strictures. The administration of inhaled or systemic corticosteroids results in symptomatic improvement in nearly 95 % of patients. A trial with corticosteroids before bougienage may reduce active inflammation and therefore the complication rate of the procedure.
Schlüsselwörter
Eosinophile - Ösophagitis
Key words
Eosinophilic - esophagitis
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1 Anmerkung: Deutsche Übersetzung der Originalübersicht, Endoscopy 2006; 38 (5): 515-520 von H.-J. Schulz.
Prof. Dr. H.-J. Schulz
Sana Klinikum Lichtenberg · Oskar-Ziethen-Krankenhaus
Fanningerstraße 32
10365 Berlin
Phone: 0 30/55 18 22 10
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Email: hj.schulz@sana-kl.de
