How to Diagnose Eosinophilic Esophagitis (Eo E)?

作者：Raithel M^*; Rieker R; Hagel A; Naegel A; Neurath M; Konturek P

来源：Endoskopie Heute, 2013, 26(1): 50-55.

DOI：10.1055/s-0032-1330600

• eosinophilia
• esophagitis
• endoscopy
• diagnostic criteria for eosinophilic esophagitis

Background: Infiltrates of eosinophil granulocytes within the gastrointestinal tract (GIT) may arise from various pathological conditions (allergy, autoimmunity, idiopathic eosinophilic gastrointestinal diseases, neoplasia, parasitosis, vasculitis etc). Eosinophilic infiltrates may be located within each section of the GIT, from the esophagus down to the rectum. Eosinophilic esophagitis (Eo E) is an increasingly recognized condition and represents an important new differential diagnosis in patients presenting with dysphagia, reflux-like symptoms, motility disturbances or chest- and abdominal pain.
Methods: Diagnostic criteria for Eo E were extracted from the Erlangen Interdisciplinary Data Registry for Allergic and Inflammatory Bowel Disease and supplemented with data from a selective literature research performed in December 2012.
Results and Conclusion: Diagnosis of Eo E requires much clinical attention concerning changed eating habits, dysphagia, chest pressure, previous allergies etc and during endoscopy sometimes only peculiar inflammatory signs may be present. Typical clinical signs of Eo E are bolus obstruction in young men, increased vulnerability of the mucosa and formation of rings. Endoscopically, typical findings in Eo E are only found in one third of all patients (white plaques, ring- or length furrows, strictures), one third shows suspicious findings (mucosal edema, pale mucosa, vulnerability) and one third has normal esophageal endoscopy. For diagnosis, endoscopic findings have to be combined with histology taken from several areas of the esophagus. Histologically, Eo E is confirmed when more than 15 - 20 eosinophils/HPF are present in the tissue of the distal and proximal esophagus. Manometry, pH-monitoring, radiology, endosonography and thoracic computertomography are only used in special situations. Patients with chest pain should be checked for coronary heart disease. Further differential diagnoses are gastroesophageal reflux disease, systemic sclerosis and hypereosinophilic syndrome.

• 出版日期2013-3