Eosinophile Erkrankungen des Gastrointestinaltrakts

Abstract

The global incidence and prevalence of eosinophilic gastrointestinal diseases is rising. Clinically, acute eosinophilic esophagitis cannot be distinguished from other causes of esophagitis. Endoscopic findings like rings, webs or furrows have a lower sensitivity than previously assumed. An improvement of symptoms by proton-pump inhibitors also doesn’t rule out the diagnosis – it has to be confirmed histologically. Early therapy will prevent later complications like strictures and motility disorders. The presentation of eosinophilic gastroenteritris/colitis is even less specific. Common cause seems to be a Th2-mediated food allergy. Successful therapies include allergen-free diets and topic steroids. Additionally, in the case of proton-pump inhibitor-responsive eosinophilic esophagitis, proton pump inhibitors do not only block gastral acid production, but may also have a direct inhibitory effect on Th2-immunity. Therefore, Th2-specific biologicals have theoretical advantages, but they could not really convince in first clinical studies.

Inzidenz und Prävalenz eosinophiler Erkrankungen des Magen-Darm-Trakts steigen weltweit an. Klinisch ist die aktive eosinophile Ösophagitis aber kaum von einer akuten Ösophagitis anderer Genese zu unterscheiden. Auch Endoskopie und das Ansprechen auf Protonenpumpenhemmer sind hier keine sicheren Parameter. Das Bild der eosinophilen Gastroenteritis bzw. Kolitis ist noch unspezifischer. Kompaktes Wissen zu diesem Thema bietet dieser Beitrag.

Schlüsselwörter

eosinophile Ösophagitis - eosinophile Gastroenteritis - eosinophile Kolitis - primär eosinophile Erkrankungen des Gastrointestinaltrakts

Key words

eosinophilic esophagitis - eosinophilic gastroenteritis - eosinophilic colitis - eosinophilic gastrointestinal disorders

• Literatur

• 1 Ronkainen J, Talley NJ, Aro P. et al. Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population‐based Kalixanda study. Gut 2007; 56: 615-620
• 2 Alhmoud T, Hanson JA, Parasher G. Eosinophilic Gastroenteritis: An Underdiagnosed Condition. Dig Dis Sci 2016; 61: 2585-2592
• 3 Arias Á, Pérez-Martínez I, Tenías JM. et al. Systematic review with meta‐analysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population‐based studies. Aliment Pharmacol Ther 2016; 43: 3-15
• 4 Benninger MS, Strohl M, Holy CE. et al. Prevalence of atopic disease in patients with eosinophilic esophagitis. Int Forum Allergy Rhinol 2017; 7: 757-762
• 5 Mori Y, Iwasaki H, Kohno K. et al. Identification of the human eosinophil lineage-committed progenitor: revision of phenotypic definition of the human common myeloid progenitor. J Exp Med 2009; 206: 183-193
• 6 Matthews AN, Friend DS, Zimmermann N. et al. Eotaxin is required for the baseline level of tissue eosinophils. Proc Nat Acad Sci USA 1998; 95: 6273-6278
• 7 Aceves SS, Newbury RO, Dohil R. et al. Esophageal remodeling in pediatric eosinophilic esophagitis. J Allergy Clin Immunol 2007; 119: 206-212
• 8 Reed C, Woosley JT, Dellon ES. et al. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis. Dig Liver Dis 2015; 47: 197-201
• 9 Mutalib M, Blackstock S, Evans V. et al. Eosinophilic gastrointestinal disease and inflammatory bowel disease in children: is it a disease continuum?. Eur J Gastroenterol Hepatol 2015; 27: 20-23
• 10 Phaw NA, Tsai HH. Eosinophilic gastroenteritis: a challenge to diagnose and treat. BMJ Case Rep 2016; 9: 2016
• 11 Miehlke S. Clinical features of eosinophilic esophagitis. Dig Dis 2014; 32: 61-67
• 12 Lucendo AJ, Molina-Infante J, Arias Á. et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United Europ Gastroenterol J 2017; 5: 335-358
• 13 Dellon ES, Hirano I. Epidemiology and Natural History of Eosinophilic Esophagitis. Gastroenterology 2018; 154: 319-332
• 14 Schlag C, Miehlke S, Heiseke A. et al. Peripheral blood eosinophils and other non-invasive biomarkers can monitor treatment response in eosinophilic oesophagitis. Aliment Pharmacol Ther 2015; 42: 1122-1230
• 15 Zhang L, Duan L, Ding S. et al. Eosinophilic gastroenteritis: clinical manifestations and morphological characteristics, a retrospective study of 42 patients. Scand J Gastroenterol 2011; 46: 1074-1080
• 16 von Arnim U, Röhl FW, Miehlke S. et al. Clinical symptom tool that raises the index of suspicion for eosinophilic oesophagitis in adults and drives earlier biopsy for definitive diagnosis. Aliment Pharmacol Ther 2017; 45: 417-426
• 17 Redondo-Cerezo E, Cabello MJ, González Y. et al. Eosinophilic gastroenteritis: our recent experience: one-year experience of atypical onset of an uncommon disease. Scand J Gastroenterol 2001; 36: 1358-1360
• 18 Teng X, Xu L, Wu J. et al. Clinical and morphological features of serosal form of eosinophilic gastroenteritis in a retrospective study of 10 children. Fetal Pediatr Pathol 2013; 32: 276-283
• 19 von Arnim U, Kandulski A, Weigt J. et al. Correlation of High-Resolution Manometric Findings with Symptoms of Dysphagia and Endoscopic Features in Adults with Eosinophilic Esophagitis. Dig Dis 2017; 35: 472-477
• 20 Pleet JL, Taboada S, Rishi A. et al. Rings in the esophagus are not always eosinophilic esophagitis: Case series of ring forming lymphocytic esophagitis and review of the literature. Endosc Int Open 2017; 5: E484-E488
• 21 Kim HP, Vance RB, Shaheen NJ. et al. The Prevalence and Diagnostic Utility of Endoscopic Features of Eosinophilic Esophagitis: A Meta-Analysis. Clin Gastroenterol Hepatol 2012; 10: 988-996
• 22 van Rhijn BD, Verheij J, Smout AJ. et al. The Endoscopic Reference Score shows modest accuracy to predict histologic remission in adult patients with eosinophilic esophagitis. Neurogastroenterol Motil 2016; 28: 1714-1722
• 23 Kinoshita Y, Furuta K, Ishimaura N. et al. Clinical characteristics of Japanese patients with eosinophilic esophagitis and eosinophilic gastroenteritis. J Gastroenterol 2013; 48 (03) 333-339
• 24 Furuta GT, Liacouras CA, Collins MH. et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007; 133: 1342-1363
• 25 Lwin T, Melton SD, Genta RM. Eosinophilic gastritis: histopathological characterization and quantification of the normal gastric eosinophil content. Mod Pathol 2011; 24: 556-563
• 26 Lee CK, Kim HJ. Primary eosinophilic colitis as an unusual cause of chronic diarrhea. Endoscopy 2010; 42: E279-E280
• 27 Carpenter HA, Talley NJ. The importance of clinicopathological correlation in the diagnosis of inflammatory conditions of the colon: histological patterns with clinical implications. Am J Gastroenterol 2009; 95: 878-896
• 28 Arias A, González-Cervera J, Tenias JM. et al. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology 2014; 146: 1639-1648
• 29 Spergel JM, Brown-Whitehorn TF, Cianferoni A. et al. Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. J Allergy Clin Immunol 2012; 130: 461-467
• 30 Gonsalves N, Yang GY, Doerfler B. et al. Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology 2012; 142: 1451-1459
• 31 Lucendo AJ. Meta-Analysis-Based Guidance for Dietary Management in Eosinophilic Esophagitis. Curr Gastroenterol Rep 2015; 17: 464
• 32 Greuter T, Bussmann C, Safroneeva E. et al. Long-Term Treatment of Eosinophilic Esophagitis With Swallowed Topical Corticosteroids: Development and Evaluation of a Therapeutic Concept. Am J Gastroenterol 2017; 112: 1527-1535
• 33 Miehlke S, Hruz P, Vieth M. et al. A randomised, double-blind trial comparing budesonide formulations and dosages for short-term treatment of eosinophilic oesophagitis. Gut 2016; 65: 390-399
• 34 Assa’ad AH, Gupta SK, Collins MH. et al. An antibody against IL-5 reduces numbers of esophageal intraepithelial eosinophils in children with eosinophilic esophagitis. Gastroenterology 2011; 141 (05) 1593-1604
• 35 Phaw NA, Tsai HH. Eosinophilic gastroenteritis: a challenge to diagnose and treat. BMJ Case Rep 2016; 9: 2016
• 36 Miehlke S, Schlag C, Storr M. et al. Eosinophile Ösophagitis Update 2017: Neue Leitlinien der europäischen Studiengruppe EUREOS. Z Gastroenterol 2018; 56: 139-150
• 37 Yamada Y, Toki F, Yamamoto H. et al. Proton pump inhibitor treatment decreased duodenal and esophageal eosinophilia in a case of eosinophilic gastroenteritis. Allergol Int 2015; 64: S83-S85
• 38 Miehlke S. Clinical features of Eosinophilic esophagitis in children and adults. Best Pract Res Clin Gastroenterol 2015; 29: 739-748
• 39 Moawad FJ, Cheatham JG, DeZee KJ. Meta-analysis: the safety and efficacy of dilation in eosinophilic oesophagitis. Aliment Pharmacol Ther 2013; 38: 713-720
• 40 Straumann A. Treatment of eosinophilic esophagitis: diet, drugs, or dilation?. Gastroenterology 2012; 142: 1409-1411
• 41 Chen JW, Kao JY. Eosinophilic esophagitis: update on management and controversies. BMJ 2017; 13 (359) j4482