Subscribe to RSS
DOI: 10.1055/s-2006-942094
© Georg Thieme Verlag Stuttgart · New York
Eosinophile Ösophagitis im Erwachsenenalter - Was hat sie für eine klinische Bedeutung?[*]
Eosinophilic Esophagitis in Adults: What is the Clinical Significance?Publication History
Publication Date:
27 July 2006 (online)
![](https://www.thieme-connect.de/media/endoheute/200602/lookinside/thumbnails/10.1055-s-2006-942094-1.jpg)
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
1 Anmerkung: Deutsche Übersetzung der Originalübersicht, Endoscopy 2006; 38 (5): 515-520 von H.-J. Schulz.
Literatur
- 1 Arora A S, Yamazaki K. Eosinophilic esophagitis: asthma of the esophagus?. Clin Gastroenterol Hepatol. 2004; 2 523-530
- 2 Arora A S, Perrault J, Smyrk T C. Topical corticosteroid treatment of dysphagia due to eosinophilic esophagitis in adults. Mayo Clin Proc. 2003; 78 830-835
- 3 Attwood S E, Lewis C J, Bronder C S. et al . Eosinophilic oesophagitis: a novel treatment using montelukast. Gut. 2003; 52 181-185
- 4 Attwood S, Smyrk T, Demeester T, Jones J. Esophageal eosinophilia with dysphagia: a distinct clinicopathologic syndrome. Dig Dis Sci. 1993; 38 109-116
- 5 Braghetto I, Csendes A, Smok G. et al . Histological inflammatory changes after surgery at the epithelium of the distal esophagus in patients with Barrett's esophagus: a comparison of two surgical procedures. Dis Esophagus. 2004; 17 235-242
- 6 Castro H J, Malka-Rais J, Bellanti J A. Current epidemiology of asthma: emerging patterns of asthma. Allergy Asthma Proc. 2005; 26 79-82
- 7 Cantu P, Velio P, Prada A, Penagini R. Ringed oesophagus and idiopathic eosinophilic oesophagitis in adults: an association in two cases. Dig Liver Dis. 2005; 37 129-134
- 8 Croese J, Fairley S K, Masson J W. et al . Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc. 2003; 58 516-522
- 9 Desai T K, Stecevic V, Chang C H. et al . Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc. 2005; 61 795-801
- 10 Evrard S, Louis H, Kahaleh M. et al . Idiopathic eosinophilic oesophagitis: atypical presentation of a rare disease. Acta Gastroenterol Belg. 2004; 67 232-235
- 11 Faubion W, Perrault J, Burgart L. et al . Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenterol Nutr. 1998; 27 90-93
- 12 Fox V L, Nurko S, Furuta G T. Eosinophilic esophagitis: it's not just kid's stuff. Gastrointest Endosc. 2002; 56 260-270
- 13 Gonsalves N, Kahrilas P J, Hirano I. Eosinophilic esophagitis (EE) in adults: emerging entity or misdiagnosed malady [abstract]. Gastrointest Endosc. 2005; 61 AB132
- 14 Hernandez L J, Jacobson J W, Harris S. Comparison among the perforation rates of Maloney, balloon and Savary dilation of esophageal strictures. Gastrointest Endosc. 2000; 51 460-462
- 15 Kaplan M, Mutlu E A, Jakate S. et al . Endoscopy in eosinophilic esophagitis: “feline” esophagus and perforation risk. Clin Gastroenterol Hepatol. 2003; 1 433-437
- 16 Kelley M L, Frazer J P. Symptomatic mid-esophageal webs. JAMA. 1966; 197 143-146
- 17 Landres R T, Kuster G G, Strum W B. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978; 74 1298-1301
- 18 Langdon D E. Corrugated ringed and too small esophagi. Am J Gastroenterol. 1999; 94 542-543
- 19 Langdon D E. Corrugated ringed esophagus [letter]. Am J Gastroenterol. 1993; 88 1461
- 20 Langdon D E. Fluticasone in eosinophilic corrugated ringed esophagus. Am J Gastroenterol. 2001; 96 926-927
- 21 Lim J R, Gupta S K, Croffie J M. et al . White specks in the esophageal mucosa: an endoscopic manifestation of non-reflux eosinophilic esophagitis in children. Gastrointest Endosc. 2004; 59 835-838
- 22 Liacouras C, Wenner W, Brown K, Ruchelli E. Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr. 1998; 26 380-385
- 23 Liacouras C A. Eosinophilic esophagitis in children and adults. J Pediatr Gastroenterol Nutr. 2003; 37 (Suppl 1) S23-S28
- 24 Lucendo A J, Carrion G, Navarro M. et al . Eosinophilic esophagitis in adults: an emerging disease. Dig Dis Sci. 2004; 49 1884-1888
- 25 Mann N S, Leung J W. Pathogenesis of esophageal rings in eosinophilic esophagitis. Med Hypotheses. 2005; 64 520-523
- 26 Meyer G W. Eosinophilic esophagitis in a father and a daughter. Gastrointest Endosc. 2005; 61 932
- 27 Morrow J B, Vargo J J, Goldblum J R, Richter J E. The ringed esophagus: histological features of GERD. Am J Gastroenterol. 2001; 96 984-989
- 28 Nurko S, Teitelbaum J E, Husain K. et al . Association of Schatzki ring with eosinophilic esophagitis in children. J Pediatr Gastroenterol Nutr. 2004; 38 436-441
- 29 Patel S M, Falchuk K R. Three brothers with dysphagia caused by eosinophilic esophagitis. Gastrointest Endosc. 2005; 61 165-167
- 30 Potter J W, Saeian K, Staff D. et al . Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest Endosc. 2004; 59 355-361
- 31 Riley S A, Attwood S EA. Guidelines on the use of oesophageal dilation in clinical practice. Gut. 2004; 53 (Suppl I) i1-i6
- 32 Roberts-Thomson I C. Images of interest. Gastrointestinal: eosinophilic esophagitis. J Gastroenterol Hepatol. 2005; 20 1299
- 33 Ruiz-Rebollo M L, Atienza-Sanchez R, Perez-Alonso P. A new case of eosinophilic esophagitis. Dis Esophagus. 2004; 17 176-179
- 34 Sant'Anna A M, Rolland S, Fournet J C. et al . Eosinophilic esophagitis in children: symptoms, histology and pH probe results. J Pediatr Gastroenterol Nutr. 2004; 39 373-377
- 35 Sgouros S N, Vlachogiannakos J, Karamanolis G. et al . Long-term acid suppressive therapy may prevent the relapse of lower esophageal (Schatzki's) rings: a prospective, randomized, placebo-controlled study. Am J Gastroenterol. 2005; 100 1929-1934
- 36 Steiner S J, Gupta S K, Croffie J M, Fitzgerald J F. Correlation between number of eosinophils and reflux index on same-day esophageal biopsy and 24-hour esophageal pH monitoring. Am J Gastroenterol. 2004; 99 801-805
- 37 Straumann A, Spichtin H P, Bucher K A. et al . Eosinophilic esophagitis: red on microscopy, white on endoscopy. Digestion. 2004; 70 109-116
- 38 Straumann A, Spichtin H P, Grize L. et al . Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology. 2003; 125 1660-1669
- 39 Straumann A, Rossi L, Simon H U. et al . Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic esophagitis?. Gastrointest Endosc. 2003; 57 407-412
- 40 Stevoff C, Rao S, Parsons W. et al . EUS and histopathologic correlates in eosinophilic esophagitis. Gastrointest Endosc. 2001; 54 373-377
- 41 Teitelbaum J E, Fox V L, Twarog F J. et al . Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology. 2002; 122 1216-1225
- 42 Vasilopoulos S, Murphy P, Auerbach A. et al . The small-caliber esophagus: an unappreciated cause of dysphagia for solids in patients with eosinophilic esophagitis. Gastrointest Endosc. 2002; 55 99-106
- 43 Vitellas K M, Bennett W F, Bova J G. et al . Idiopathic eosinophilic esophagitis. Radiology. 1993; 186 789-793
- 44 Zapata R, Olivero M, Aponte P. et al . Eosinophilic esophagitis or asthma of the esophagus: first case series report from Chile [abstract]. Gastrointest Endosc. 2005; 61 AB146
- 45 Zimmerman S L, Levine M S, Rubesin S E. et al . Idiopathic eosinophilic esophagitis in adults: the ringed esophagus. Radiology. 2005; 236 159-165
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
Fax: 0 30/55 18 22 50
Email: hj.schulz@sana-kl.de