Slovenska priporočila za obravnavo odraslih bolnikov z eozinofilnim ezofagitisom
DOI:
https://doi.org/10.6016/ZdravVestn.3392Ključne besede:
eozinofilni ezofagitis, diagnoza, zdravljenje, zapletiPovzetek
Eozinofilni ezofagitis (EoE) je kronično, imunsko pogojeno vnetje celotne stene požiralnika, ki povzroča disfagijo in zatikanje hrane pri odraslih bolnikih, probleme pri hranjenju, bolečine v zgornjem delu trebuha in za prsnico, pri otrocih pa tudi bruhanje. Diagnozo postavimo na osnovi histološke analize bioptov sluznice požiralnika (najmanj 6 biopsij) in dokazom eozinofilnega vnetja z ≥ 15 eozinofilnih granulocitov na polje velike povečave oz. z dokazom > 60 eozinofilnih granulocitov/mm2 in odsotnostjo drugih bolezni, povezanih z eozinofilnim vnetjem požiralnika. Eozinofilni ezofagitis je imunski odgovor Th2 na alergene v hrani pri bolnikih z genetsko predispozicijo. Po oceni je bolezen prisotna pri 1/2.000 prebivalcev. Bolniki imajo pogosto tudi druge alergične bolezni, kot so astma, alergijski rinitis, ekcem, atopični dermatitis.
Nezdravljena bolezen lahko vodi v stenotične spremembe celotne stene požiralnika. V klinični sliki odraslih prevladuje simptom disfagije, impakcija hrane ali bolečine za prsnico. Pri 7–17 % bolnikih z dokazanim EoE je endoskopska slika požiralnika normalna. Pri ostalih bolnikih endoskopija odkrije znak vzdolžne brazde, obroče (trahealizacija požiralnika), belkaste eksudate, edem sluznice in/ali ožji požiralnik oz. strikture požiralnika.
Obstajajo 3 možne oblike zdravljenja: izločitvene diete, zdravljenje z zaviralci protonske črpalke ali lokalno zdravljenje z kortikosteroidi. Uspeh zdravljenja ocenjujemo z endoskopijo in 6 biopsijami požiralnika 3 mesece po uvedbi zdravljenja. Ko bolnik doseže histološko in klinično remisijo, je potrebno trajno nadaljevanje zdravljenja. Pri t. i. vzdrževalnem zdravljenju običajno uporabimo polovične odmerke zdravil, ki so bolniku pomagala do remisije, oziroma izključitveno dieto. Če se ugotovi fibrostenotična oblika bolezni (dolgotrajna nediagnosticirana bolezen brez zdravljenja) je potreben ukrep endoskopske dilatacije požiralnika.
Prenosi
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