Eosinophile Ösophagitis – Neues zur Pathogenese, Diagnostik und Therapie

Ulrike von Arnim; S. Miehlke; A. Madisch; M Vieth; A. Straumann; P. Malfertheiner

doi:10.1055/s-0042-119417

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2017; 96(01): 11-21
DOI: 10.1055/s-0042-119417

Übersicht

Eosinophile Ösophagitis – Neues zur Pathogenese, Diagnostik und Therapie^[*]

Eosinophilic Esophagitis – Update – Pathogenesis, Diagnosis and Therapy

Authors

Ulrike von Arnim

¹Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg AöR, Magdeburg
S. Miehlke

²Magen-Darm-Zentrum, Facharztzentrum Eppendorf, Hamburg
A. Madisch

³Medizinischen Klinik I, KRH Klinikum Siloah, Hannover
M Vieth

⁴Institut für Pathologie, Klinikum Bayreuth GmbH, Bayreuth
A. Straumann

⁵Swiss EoE Clinic, Olten, Switzerland
P. Malfertheiner

¹Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg AöR, Magdeburg

Abstract

Zusammenfassung

Die eosinophile Ösophagitis (EoE) ist eine Krankheitsentität, der man erst im letzten Jahrzehnt eine erhöhte Aufmerksamkeit gewidmet hat und seitdem wird sie mit deutlich erhöhter Frequenz diagnostiziert. Sie stellt eine chronisch immunvermittelte Entzündung des Ösophagus dar. Bei Erwachsenen ist die Dysphagie das Leitsymptom. Die Diagnose wird durch die Ösophago-Gastro-Duodenoskopie mit Entnahme von Stufenbiopsien aus dem Ösophagus gestellt. Die charakteristischen histopathologischen Veränderungen mit eosinophilen Infiltraten der ösophagealen Mukosa sind der diagnostischen Goldstandard. Bislang gibt es weltweit keine zugelassene Therapie für die EoE, auch wenn topische und systemisch wirkende Kortikosteroide eine hohe Wirksamkeit zeigen. Weitere therapeutische Optionen stellt die Eliminationsdiät und in ausgewählten Fällen die endoskopische Dilatation dar.

Abstract

Eosinophilic esophagitis (EoE) is a clinicopathological condition of the esophagus that has become increasingly recognised over the last decade. EoE represents a chronic immune-mediated inflammatory disease of the esophagus. In adults dysphagia is the predominant symptom. Upper gastrointestinal endoscopy is required in order to take biopsies from the esophagus. The diagnose is confirmed histologically by typical eosinophilic infiltration of the esophagus mucosa. Until now there is no approved therapy world-wide although we know that topic and systemic steroids are highly effective in EoE. Elimination diet is another option and in well selected patients endoscopic balloon dilation represents a therapeutic possibility.

Schlüsselwörter

Ösophagus - eosinophile Ösophagitis - GERD

Key words

esophagus - eosinophilic esophagitis - GERD

Full Text

References

Literatur
1 von Arnim U et al. Eosinophile Ösophagitis-Pathogenese klinische Präsentation und therapeutisches Management. Z Gastroenterol 2007; 45: 1257-1263
2 Furuta GT, Liacouras CA, Collins MH et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommandations for diagnosis and treatment. Gastroentrology 2007; 133: 1342-1363
3 Spechler SJ, Genta RM, Souza RF. Thoughts on complex relationship between gastroesophageal reflux disease and eosinophilic esophagitis. Am J Gastroenterol 2007; 102: 1301-1306
4 Liacouras CA, Furuta GT, Hirano I et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128: 3-20
5 Gupte AR, Draganov PV. Eosinophilic esophagitis. World J Gastroenterol 2009; 15: 17-24
6 Hurrell JM, Genta RM, Dellon ES. Prevalence of esophageal eosinophilia varies by climate zone in the United States. Am J Gastroenterol 2012; 107: 698-706
7 Kapel RC, Miller JK, Torres C et al. Eosinophilic esophagitis: A prevalent disease in the United States that affects all age groups. Gastroenterology 2008; 134: 1316-1321
8 Prasad GA, Alexander JA, Schleck CD et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol 2009; 7: 1055-1061
9 Syed AA, Andrews CN, Shaffer E et al. The rising incidence of eosinophilic oesophagitis is associated with increasing biopsy rates: a population-based study. Aliment Pharmacol Ther 2012; 36: 950-958
10 Hruz P et al. Escalating incidence od eosinophilic esophagitis: A 20 year prospective, population-based study in Olten county Switzerland. J Allerg Clin Immunol 2011; 128: 1349-1350
11 Straumann A, Simon HU. Eosinophilic esophagitis: escalating epidemiology?. Allergy Clin Immunol 2005; 115: 418-419
12 Ronkainen J, Talley NJ, Aro P et al. Prevalence of oesophageal eosinophils and eosniphilic oesophagitis in adults: Kalixanda study. Gut 2007; 56: 615-625
13 Cherian S, Smith NM, Forbes DA. Rapidly increasing prevalence of eosinophilic esophagitis in Western Australia. Arch Dis Child 2006; 91: 1000-1004
14 Shi YN, Sun SJ, Xiong LS et al. Prevalence, clinical manifestations and endoscopic features of eosinophilic esophagitis: a pathological review in China. J Dig Dis 2012; 13: 304-309
15 Straumann A, Spichtin HP, Bernoulli R et al. Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings [in German with English abstract]. Schweiz MedWochenschr 1994; 124: 1419-1429
16 Croese J, Fairley SK, Masson JW et al. Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc 2003; 58: 516-522
17 Straumann A, Beglinger C. Eosinophilic esophagitis: the endoscopist's enigma. Gastrointest Endosc 2006; 63: 13-15
18 Syed AAN, Andrews CN, Shaffer E et al. The rising incidence of eosinophilic esophagitis is associated with increasing biopsy rates: a population based study. Aliment Pharmacol Ther 2012; 36: 950-958
19 Sealock RJ, Rendon G et al. Systematic review: the epidemiology of eosinophilic esophagitis in adults. Aliment Pharmacol Ther 2010; 32: 712-719
20 Rothenberg ME. Biology and treatment of eosinophilic esophagitis. Gastroenterology 2009; 137: 1238-1249
21 Blanchard C, Wang N, Stringer KF et al. Eotaxin 3 and a uniquely conserved gen-expression profile in eosinophilic esophagitis. J Clin Invest 2006; 116: 536-544
22 Kelly KJ, Lazenby AJ, Rowe PC et al. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995; 109: 1503-1512
23 Akei HS, Mishra A, Blanchard C et al. Epicutaneous antigen exposure primes for experimental eosinophilic esophagitis in mice. Gastroenterology 2005; 129: 985-994
24 Almansa C, KrishnaM Buchner AM. et al. Seasonal distribution in newly diagnosed cases of eosinophilic esophagitis in adults. Am J Gastroenterol 2009; 104: 828-833
25 Mishra A, Hogan SP, Brandt EB et al. An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001; 107: 83-90
26 Mishra A, Wang M, Pemmaraju VR et al. Esophageal remodeling develops as a consequence of tissue specific IL-5-induced eosinophilia. Gastroenterology 2008; 134: 204-214
27 Mishra A, Rothenberg ME. Intratracheal IL-13 induces eosinophilic esophagitis by an IL-5, eotaxin-1, and STAT6-dependent mechanism. Gastroenterology 2003; 125: 1419-1427
28 Zhu X, Wang M, Mavi P et al. Interleukin-15 expression is increased in human eosinophilic esophagitis and mediates pathogenesis in mice. Gastroenterology 2010; 139: 182-193
29 Lucendo AJ, Arias A, De Rezende LC et al. Subepithelial collagen deposition, profibrogenic cytokine gene expression, and changes after prolonged fluticasone propionate treatment in adult eosinophilic esophagitis: a prospective study. J Allergy Clin Immunol 2011; 128: 1037-1046
30 Collins MH, Blanchard C, Abonia JP et al. Clinical, pathologic, and molecular characterization of familial eosinophilic esophagitis compared with sporadic cases. Clin Gastroenterol Hepatol 2008; 6: 621-629
31 Noel RJ, Putnam PE, Rothenberg ME. . N Engl J Med 2004; 351: 940-941
32 Rothenberg ME, Spergel JM, Sherrill JD et al. Common variants at 5q22 associate with pediatric eosinophilic esophagitis . Nat Genet 2010; 42: 289-291
33 Sherrill JD, Gao PS, Stucke EM et al. Variants of thymic stromal lymphopoetin and its receptor associate with eosinophilic esophagitis. J Allergy Clin Immunol 2010; 126: 160-165
34 Blanchard C, Stucke EM, Burwinkel K et al. Coordinate interaction between IL-13 and epithelial differentiation cluster genes in eosinophilic esophagitis. J Immunol 2010; 184: 4033-4041
35 Franciosi JP, Liacouras CA. Eosinophilic esophagitis. Immunol Allergy Clin N Am 2009; 29: 19-27
36 Liacouras CA, Spergel JM, Ruchelli E et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroeterol Hepatol 2005; 12: 1198-1206
37 Dellon ES, Gibbs WB, Fritchie KJ et al. Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2009; 7: 1305-1313
38 Prasad GA, Talley NJ, Romero Y et al. Prevalence and predicitive factors of eosinophilic esophagitis in patients presenting with dyspahgia: a prospective study. Am J Gastroenterol 2007; 102: 2627-2632
39 Desai TK, Stecevic V, Chang CH et al. Association of eosinophilic inflammation with esophageal foodimpaction in adults. Gastrointest Endosc 2005; 61: 795-801
40 Kerlin P, Jones D, Remedios M et al. Prevalence of eosinophilic esophagitis in adults with food bolus obstruction of the esophagus. J Clin Gastroenterol 2007; 41: 356-361
41 Dellon ES, Aderoju A, Woosley JT et al. Variability in diagnostic criteria für eosinophilic esophagitis: A systematic review. Am J Gastroeterol 2007; 102: 2300-2013
42 Veerappan GR, Perry JL, Duncan TJ et al. Prevalence of eosinophilic esophagitis in adult population undergoing upper endoscopy: a prospective study. Clin Gastroenterol Hepatol 2009; 7: 420-426
43 Foroutan M, Nrouzi A, Molaei M et al. Eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease. Dig Dis Sci 2010; 55: 28-31
44 Poh CH, Gasiorowska A, Navarro-Rodriguez T et al. Upper GI tract findings in patients with heartburn in whom proton pump inhibitor treatment failed versus those not receiving antireflux treatment. Gastrointest Endosc 2010; 71: 28-34
45 Roy-Ghanta S, Larosa DF, Katzka DA. Atopic characteristics of adult patients with eosinophilic esophagitis. Clin Gastroentrol Heptatol 2008; 6: 531-535
46 Aceves SS, Newbury RO, Dhil R et al. Distinguishing eosinphilic esophagitis in pedriatic patients: clinical, endoscopic, and histologic features of an emerging disorder. J Clin Gastroeterol 2007; 41: 252-256
47 Chehade M, Sampson HA. Epidemiology and etiology of eosniphilic esophagitis. Gastrointest Endosc North Am 2008; 18: 33-44
48 Erwin EA, James HR, Gutekunst HM et al. Serum IgE measurement and detection of food allergy in pedriatic patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 2010; 139: 418-429
49 von Arnim U, Wex T, Röhl FW et al. Identification of clinical and laboratory markers for predicting eosinophilic esophagitis in adults. Digestion 2011; 84: 323-327
50 Straumann A, Spichtin HP, Bucher KA et al. Eosinophilic esophagitis: red on microscopy, white on endoscopy?. Digestion 2004; 70: 109-116
51 Straumann A, Rossi L, Simon HU et al. Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic oesophagitis?. Gastrointest Endosc 2003; 57: 407-412
52 Müller M, Eckardt AJ, Fisseler-Eckhoff A et al. Endoscopic findings in patients with Schatzki rings: evidence for an association with eosinophilic esophagitis. World J Gastroenterol 2012; 18: 6960-6966
53 Kaplan M, Mutlu EA, Jakate S et al. Endoscopy in eosinophilic esophagitis: “feline” oesophagus and perforation risk. Clin Gastroenterol Hepatol 2003; 1: 433-437
54 Dohil R, Newbury R, Fox L et al. Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Gastroenterology 2010; 139: 418-429
55 Straumann A, Conus S, Degen L et al. Budesonide is effective in adolescent and adult patients with active eosinophilic esophagitis. Gastroenterology 2010; 139: 1526-1537
56 Peterson KA, Thomas KL, Hilden K et al. Comparison of esomeprazole to aerosolized, swallowed fluticasone for eosinophilic esophagitis. Dig Dis Sci 2010; 55: 1313-1319
57 Gonsalves N, Policarpio-Nicolas M, Zhang Q et al. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc 2006; 64: 313-319
58 Straumann A, Conus S, Degen L et al. Long-term budesonide maintenance treatment is partially effective for patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2011; 9: 400-409
59 Hirano I, Moy N, Heckman MG et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013; 62: 489-495
60 Kaijser R. Zur Kenntnis der allergischen Affektionen des Verdauugskanals vom Standpunkt des Chirurgen aus. Langenbecks Arch Klein Chir 1937; 188: 36-64
61 Dobbins JW, Sheahan DG, Behar J. Eosinophilic gastroenteritis with esophageal involvement. Gastroenterology 1977; 72: 1312-1316
62 Vieth M, Stolte M. Eosinophilic esophagitis: a largely unknown entity?. Z Gastroenterol 2000; 38: 447-448
63 Dellon ES, Fritchie KJ, Rubinas TC et al. Inter- and intraobserver reliability and validation of a new method for determination of eosinophil counts in patients with esophageal eosinophilia. Dig Dis Sci 2010; 55: 1940-1999
64 Fiocca R, Mastracci L, Riddell R et al. Development of consensus guidelines for the histologic recognition of microscopic esophagitis in patients with gastroesophageal reflux disease: the Esohisto project. Hum Pathol 2010; 41: 223-231
65 Yerian L, Fiocca R, Mastracci L et al. Refinement and reproducibility of histologic criteria for the assessment of microscopic lesions in patients with gastroesophageal reflux disease: the Esohisto Project. Dig Dis Sci 2011; 56: 2656-2665
66 Bussmann C, Straumann A. Eosinophilic esophagitis. The diagnostic contribution of pathology. Pathologe 2013; 34: 110-117
67 Straumann A, Aceves SS, Blanchard C et al. Pediatric and adult eosinophilic esophagitis: similarities and differences. Allergy 2012; 67: 477-490
68 Ismail-Beigi F, Horton PF, Pope 2nd CE. Histological consequences of gastroesophageal reflux in man. Gastroenterology 1970; 58: 163-174
69 Ismail-Beigi F, Pope 2nd CE. Distribution of the histological changes of gastroesophageal reflux in the distal esophagus of man. Gastroenterology 1974; 66: 1109-1113
70 Vieth M, Fiocca R, Wernersson B et al. Evaluation of histologic criteria for the diagnosis of gastroesophageal reflux disease. Gastroenterology 2011; 140: S-95
71 Solcia E, Villani L, Luinetti O et al. Altered intercellular glycoconjugates and dilated intercellular spaces of esophageal epithelium in reflux disease. Virchows Arch 2000; 436: 207-216
72 Aceves SS, Newbury RO, Dohil R et al. Esophageal remodeling in pediatric eosinophilic esophagitis. J Allergy Clin Immunol 2007; 119: 206-212
73 Safdarian N, Liu Z, Zhou X et al. Quantifying human eosinophils using three-dimensional volumetric images collected with multiphoton fluorescence microscopy. Gastroenterology 2012; 142: 15-20
74 Protheroe C, Woodruff SA, de Petris G et al. A novel histologic scoring system to evaluate mucosal biopsies from patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2009; 7: 749-755
75 Mueller S, Neureiter D, Aigner T et al. Comparison of histological parameters for the diagnosis of eosinophilic oesophagitis versus gastrooesophageal reflux disease on oesophageal biopsy material. Histopathology 2008; 53: 676-684
76 Rubio CA, Sjödahl K, Lagergren J. Lymphocytic esophagitis: a histologic subset of chronic esophagitis. Am J Clin Pathol 2006; 125: 432-437
77 Teitelbaum JE, Fox VL, Twarog FJ et al. Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 2002; 122: 1216-1225
78 Schaefer ET, Fitzgerald JF, Molleston JP et al. Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis: a randomized trial in children. Clin Gastroenterol Hepatol 2008; 6: 165-173
79 Alexander JA, Jung KW, Arora AS et al. Swallowed Fluticasone Improves Histologic but not Symptomatic Responses of Adults with Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2012; 10: 742-749
80 Dellon ES, Sheikh A, Speck O et al. Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis. Gastroenterology 2012; 143: 321-324
81 Miehlke S, Hruz P, von Arnim U et al. Randomized, double-blind, placebo-controlled multicenter phase-2 trial of budesonide effervescent tablet and budesonide viscous suspension for short-term treatment of eosinophilic esophagitis. UEGW 2013
82 Attwood SE, Lewis CJ, Bronder CS et al. Eosinophilic esophagitis: a novel treatment using Montelukast. Gut 2003; 52: 181-185
83 Lucendo AJ, De Rezende LC, Jiménez-Contreras S et al. Montelukast was inefficient in maintaining steroid-induced remission in adult eosinophilic esophagitis. Dig Dis Sci 2011; 56: 3551-358
84 Straumann A, Hoesli S, Bussmann C et al. Anti-eosinophil activity and clinical efficacy of the CRTH2 antagonist OC000459 in eosinophilic esophagitis. Allergy 2013; 68: 375-385
85 Netzer G, Gschossmann JM, Straumann A et al. Corticosteroid-dependent eosinophilic esophagitis: azathioprin and 6-mercaptopurine can induce and maintain long-term remission. Eur J Gastroenterol Hepatol 2007; 19: 865-869
86 Straumann A, Conus S, Grzonka P et al. Anti-interleukin-5 antibody treatment (mepolizumab) in active eosinophilic oesophagitis: a randomized, placebo-controlled, double-blind trial. Gut 2010; 59: 21-30
87 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: 1593-1604
88 Spergel JM, Rothenberg ME, Collins MH et al. Reslizumab in children and adolescents with eosinophilic esophagitis: results of a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol 2012; 129: 456-463
89 Molina-Infante J, Ferrando-Lamana L, Ripoll C et al. Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults. Clin Gastroenterol Hepatol 2011; 9: 110-117
90 Moawad FJ, Veerappan GR, Dias JA et al. Randomized controlled trial comparing aerosolized swallowed fluticasone to esomeprazole for esophageal eosinophilia. Am J Gastroenterol 2012; 108: 366-372
91 Cheng E, Zhang X, Huo X et al. Omeprazole blocks eotaxin-3 expression by oesophageal squamous cells from patients with eosinophilic oesophagitis and GORD. Gut 2012; 7 [Epub ahead of print]
92 Hirano I. Editorial: should patients with suspected eosinophilic esophagitis undergo a therapeutic trial of proton pump inhibition?. AmJ Gastroenterol 2012; 108: 373-375
93 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
94 Lucendo AJ, Arias A, González-Cervera J et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: A prospective study on the food cause of the disease. J Allergy Clin Immunol 2013; 131: 797-804
95 Peterson KA, Byrne KR, Vinson LA et al. Elemental diet induces histologic response in adult eosinophilic esophagitis. Am J Gastroenterol 2013; [Epub ahead of print]
96 Schoepfer AM, Gonsalves N, Bussmann C et al. Esophageal dilation in eosinophilic esophagitis: effectiveness, safety, and impact on the underlying inflammation. Am J Gastroenterol 2010; 105: 1062-1070
97 Jung KW, Gundersen N, Kopacova J et al. Occurrence of and risk factors for complications after endoscopic dilation in eosinophilic esophagitis. Gastrointest Endosc 2011; 73: 15-21
98 Straumann A, Bussmann C, Zuber M et al. Eosinophilic esophagitis: analysis of food impactation and perforation in 251 adolescent and adult patients. Clin Gastroenterol Hepatol 2008; 6: 598-600

Eosinophile Ösophagitis – Neues zur Pathogenese, Diagnostik und Therapie[*]

Authors

Eosinophile Ösophagitis – Neues zur Pathogenese, Diagnostik und Therapie^[*]