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HNO

, Volume 66, Issue 7, pp 534–542 | Cite as

Eosinophilic esophagitis: an underdiagnosed cause of dysphagia and food impaction to be recognized by otolaryngologists

  • C. Górriz GilEmail author
  • V. Matallana Royo
  • Ó. Álvarez Montero
  • A. Rodríguez Valiente
  • C. Fernández Manzano
  • B. Conde García
  • J. R. García-Berrocal
Leitthema

Abstract

Eosinophilic esophagitis (EoE) is a recently recognised pathologic entity whose prevalence has risen significantly since first being described in 1993. Defined as a chronic, local immune-mediated disease with predominant eosinophil infiltration, it is nowadays the leading cause of dysphagia and food bolus impaction in children and young adults. Genetic and environmental risk factors, and especially food antigens, trigger the disease and are in the focus of investigation as avoidance can cure three quarters of patients. The most common antigen involved is milk, followed by egg and gluten. These patients frequently come undiagnosed to the otolaryngologist with complaints of dysphagia and recurrent non-sharp food impactions, although pharyngolaryngeal reflux symptoms and other airway complaints could also be a first sign. Delayed diagnosis and treatment can produce fibrostenosis of the esophagus that greatly impairs patients’ quality of life.

In-office transnasal esophagoscopy with esophageal biopsy offers a unique opportunity to promptly diagnose and follow-up these patients, without causing the morbidity of repeated sedations and reducing exploration overload in gastroenterology departments. The search for food-antigen triggers, response evaluation to swallowed steroids, or proton pump inhibitors (PPIs) make multiple endoscopies and biopsies necessary every 6 to 8 weeks.

There are three first-line interchangeable treatments with the same recommendation: PPIs, dietary allergen elimination and topical swallowed steroids. The choice should be discussed with the patient on an individual basis.

The objective of this article is to raise awareness of this condition, update otolaryngologists with the new EoE consensus, and highlight the need for biopsy in patients with dysphagia to rule out EoE.

Keywords

Antigen Milk Gastroesophageal reflux disease Gluten Esophagoscopy 

Eosinophile Ösophagitis: Eine zu selten diagnostizierte Ursache von Dysphagie und Nahrungsimpaktion, die der HNO-Arzt erkennen sollte

Zusammenfassung

Die eosinophile Ösophagitis (EÖ) ist ein kürzlich anerkanntes Krankheitsbild, dessen Prävalenz seit der Erstbeschreibung im Jahr 1993 deutlich gestiegen ist. Definiert als eine chronische, lokale immunvermittelte Erkrankung mit überwiegend eosinophilem Infiltrat ist die EÖ heute die Hauptursache von Dysphagie und Nahrungsbolusimpaktion bei Kindern und jungen Erwachsenen. Genetische und umweltbezogene Risikofaktoren, insbesondere Nahrungsmittelantigene, lösen die Erkrankung aus und stehen im Fokus der Forschung, da ihre Vermeidung bei drei von vier Patienten zur Heilung führt. Als Antigen am häufigsten involviert ist Milch, gefolgt von Ei und Gluten. Betroffene Patienten suchen nicht selten ohne Diagnose den Hals-Nasen-Ohren-Arzt auf und klagen über Dysphagie sowie wiederholte Impaktionen nichtspitzer Nahrungsmittel, auch wenn pharyngolaryngeale Refluxsymptome und andere Atemwegsbeschwerden ebenfalls ein erstes Erkrankungszeichen sein können. Eine verzögerte Diagnose und Behandlung können eine Fibrostenose des Ösophagus zur Folge haben, die die Lebensqualität der Patienten stark beeinträchtigt.

Die transnasale Ösophagoskopie mit Ösophagusbiopsie bietet in der HNO-Praxis die einmalige Möglichkeit, unverzüglich eine Diagnose zu stellen und die Patienten weiter zu beobachten. Dabei wird eine durch wiederholte Sedierungen bedingte gesundheitliche Beeinträchtigung vermieden und die diagnostische Überlastung gastroenterologischer Abteilungen reduziert. Die Suche nach Nahrungsmittelantigenen, die als Auslöser wirken, sowie die Beurteilung des Ansprechens auf oral eingenommene Steroide oder Protonenpumpenhemmer (PPI) erfordern regelmäßige Endoskopien und Biopsien alle 6 bis 8 Wochen.

Drei gleichwertige Erstlinientherapien mit derselben Empfehlung stehen zur Auswahl: die PPI-Gabe, die Beseitigung des Nahrungsmittelallergens und die topische Behandlung mit oral eingenommenen Steroiden. Der Patient sollte in die individuelle Therapieentscheidung einbezogen werden.

Mit dem vorliegenden Beitrag soll das Bewusstsein für die EÖ geschärft werden. Zudem werden die aktuellen Konsensusempfehlungen vorgestellt. Unterstrichen werden soll die Notwendigkeit der Biopsie zum Ausschluss einer EÖ bei Patienten mit Dysphagie.

Schlüsselwörter

Antigen Milch Gastroösophageale Refluxkrankheit Gluten Ösophagoskopie 

Notes

Compliance with ethical guidelines

Conflict of interest

C. Górriz Gil, V. Matallana Royo, Ó. Álvarez Montero, A. Rodríguez Valiente, C. Fernández Manzano, B. Conde García and J. R. García-Berrocal declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

Video: Patient with eosinophilic esophagitis seen by transnasal esophagoscopy

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • C. Górriz Gil
    • 1
    Email author
  • V. Matallana Royo
    • 2
  • Ó. Álvarez Montero
    • 1
  • A. Rodríguez Valiente
    • 1
  • C. Fernández Manzano
    • 1
  • B. Conde García
    • 2
  • J. R. García-Berrocal
    • 1
  1. 1.Department of Otolaryngology Head and Neck SurgeryHospital Universitario Puerta de Hierro MajadahondaMadridSpain
  2. 2.Department of GastroenterologyHospital Universitario Puerta de Hierro MajadahondaMadridSpain

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