Eosinophile Ösophagitis - Pathogenese, klinische Präsentation und therapeutisches Management

Zusammenfassung

Die eosinophile Ösophagitis (EE, engl. eosinophilic esophagitis) repräsentiert sich als eine relativ neue, chronische, dominant TH 2-Typ-vermittelte allergieartige Entzündung der Speiseröhre. Die EE weist eine Prädilektion für das männliche Geschlecht auf. Allergische Krankheiten werden in 50 - 70 % der Patienten oder deren Familienmitgliedern berichtet. In Erwachsenen präsentiert sich die EE klinisch mit einer typischen Symptomatik der Dysphagie und Bolusobstruktion. Endoskopisch werden am häufigsten unscheinbare rötliche Längsfurchen oder mukosale Linien, weißliche Auflagerungen oder mukosale Ringe („Katzenösophagus”) gesehen. Die Diagnose wird histologisch durch die deutlich erhöhte Anzahl an eosinophilen Granulozyten in der Schleimhaut gesichert (mindestens 24 eosinophile Granulozyten/HPF). Die medikamentöse Therapie umfasst hauptsächlich Kortikosteroide, entweder systemisch oder lokal appliziert. Weitere Therapieansätze sind Leukotrienrezeptorantagonisten (Montelukast) und IL-5-blockierende Medikamente (Mepolizumab). Komplikationen in Form von Stenosen/Strikturen sollten vorsichtig endoskopisch therapiert werden. Ob mittels konsequenter antiinflammatorischer Therapie die gefürchteten Spätkomplikationen vermieden werden können, werden erst weitere Langzeitstudien zeigen.

Abstract

Eosinophilic esophagitis (EE) is a relatively new, chronic, TH 2-type allergic inflammation of the esophagus. EE occurs more frequently in men. Allergic diseases such as asthma or atopic dermatitis are present in 50 - 70 % of patients or their relatives. In adults, the most common presenting symptom of EE is dysphagia, with or without food bolus impaction. Endoscopic findings of EE include mucosal furrows, corrugated or concentric rings or ridges in the esophagus (”feline esophagus”), with or without tiny whitish exudates. The diagnosis is confirmed by the observation of high counts of eosinophils in the esophageal epithelium (at least 24 /HPF). The cornerstones of medical therapy are either topical or systemic corticosteroids. Additional therapies included leukotriene receptor antagonists (montelukast) and IL-5 blockers (Mepolizumab). Complications of EE such as esophageal strictures should be carefully dilated using either bougies or a balloon. Currently it is still not known whether the late complications of EE can be prevented by the use of anti-inflammatory agents and this can only be demonstrated through further long-term follow-up studies.

Schlüsselwörter

Ösophagus - hyperkontraktiler Ösophagus - Refluxoesophagitis - eosinophile Ösophagitis

Key words

esophagus - hypercontractile esophagus - reflux esophagitis - eosinophilic esophagitis

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