Eosinophilic esophagitis K20

Attwood SE et al., 1993

Chronic inflammatory, immune-mediated, esophageal, eosinophilic mucositis with esophageal dysfunction and eosinophilic mucosal infiltration (>15% eosinophilic granulocytes/ visual field)

Prevalence 50/100,000 inhabitants (refers to industrialised countries); m:f=3:1

Unexplained; food allergens and aerogenic allergens induce an inflammatory reaction with activation of the Th2 signaling pathway. The Th-2 cytokines (IL-13, IL-9, IL-5 ) stimulate the production of eotaxin-3 and periostin from hyperplastic epithelial cells with adhesion and recruitment of eosinophils and mast cells.

Food allergies can be detected in about 50% of cases(wheat allergy, cow's milk allergy).

In children, food allergies are mainly detected, in adults, aerogenic allergens are more suspected.

Possible at any age. Accumulation between the 30th-50th LJ

Variable intensity dysphagia, bolus obstruction, possibly heartburn or other symptoms of gastroesophageal reflux (GERD).

In children: abdominal pain is common.

In some cases, bolus obstruction may be the first clinical sign of the disease.

Often eosinophilic esophagitis is accompanied by diseases of the atopic type such as:

• Eosinophilic gastroenteritis
• Eosinophilic colitis
• bronchial asthma (24% of cases)
• atopic dermatitis
• rhinoconjunctivitis allergica
• Food allergies.

Exact comparative figures emerged in a larger study by Mohammad AA et al (2017), who compared the prevalences of patients with eosinophilic esophagitis in terms of comorbidities of asthma, allergic rhintis, and atopic dermatitis, with atopic patients without eosinophilic esophagitis. In the United States, the prevalence of:

• asthma to 22.3
• allergic rhinitis at 19.1%
• atopic dermatitis 8.3%.

estimated. In contrast, their prevalences in patients with eosinophilic esophagitis +:

• asthma at (22.3) 39.0 %
• allergic rhinitis at (19,1) 61,9 %
• in atopic dermatitis in (8,3) 46,1 %.

These constellations suggest a strong association between atopic diseases and eosinophilic esophagitis. Moreover, patients with concomitant eosinophilic esophagitis + any of these 3 atopic diseases had significantly higher peripheral eosinophil counts and higher IgE levels.

Frequently hematoeosinophilia (5-50%), IgE elevated (in up to 70% of patients - see before).

Clinical symptomatology

Haematoeosinophilia (in 5-50% of cases), increased total IgE (70% of cases).

Endoscopy of the upper intestinal tract with bioptic clarification (detection of >15 eosinophilic granulocytes per HPF (High Power Field = visual field per 400-fold magnification).

Possible endoscopic findings: reddish longitudinal furrows, crepe paper mucosa = inelastic fragile mucosa, through solitary or multiple rings (detectable in 82% of patients) the esophagus receives a trachea-like aspect, administration of proton pump inhibitors (PPI); 2/3 of patients with EoE do not respond to PPI.

Gastroesophageal reflux (K21.9);

malignancies;

motility disorders e.g. in progressive systemic scleroderma (M34.0).

Therapeutically, the so-called "3 Ds" (diet - allergen reduction, drugs (topical application of budesoside sprays), dilatation (for fixed fibrostenoses) are possible. In case of therapy resistance systemic therapy with glucocorticoids.

A two-food-group elimination (gluten-containing cereals, milk) leads to a remission of esophagitis in about 40% of the affected persons (Molina-Infante et al. 2018)

In larger studies it has been shown that outlet diets (avoidance of nutritive allergens) can result in a noticeable reduction of eosinophilic infiltration (with improvement of clinical symptoms) of the oesophagus.

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