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Inicio Medicina Clínica (English Edition) Eosinophilic esophagitis: An evidenced-based approach to diagnosis and treatment
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Vol. 152. Issue 11.
Pages 444-449 (June 2019)
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Vol. 152. Issue 11.
Pages 444-449 (June 2019)
Review
DOI: 10.1016/j.medcle.2019.04.011
Eosinophilic esophagitis: An evidenced-based approach to diagnosis and treatment
Esofagitis eosinofílica: aproximación al diagnóstico y tratamiento desde la evidencia
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Isabel Pérez-Martíneza, Luis Rodrigoa, Alfredo J. Lucendob,c,
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alucendo@vodafone.es

Corresponding author.
a Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Spain
b Sección de Aparato Digestivo, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain
c Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas CIBEREHD, Spain
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Table 1. Differential diagnosis of eosinophilic esophagitis.
Table 2. Pharmacological treatment of eosinophilic esophagitis.
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Abstract

Eosinophilic esophagitis is a unique form of non-IgE-mediated food allergy characterised by oesophageal eosinophilic infiltration. The prevalence of EoE has grown to currently represent the first cause of dysphagia and food impaction in children and young adults. Avoiding food triggers is the only therapy targeting the cause of the disease, but none of the currently available food allergy tests adequately predicts food triggers for EoE. Strategies based on the empirical elimination of food are the most effective and convenient in clinical practice. Proton pump inhibitors constitute an effective first-line therapy in half of patients, through a direct anti-inflammatory effect independent of its action on gastric acid secretion. Topical glucocorticosteroids budesonide and fluticasone reduce eosinophilic inflammation and reverse symptoms. This review includes the most relevant aspects of the epidemiology, diagnosis, treatment and monitoring of eosinophilic esophagitis.

Keywords:
Diet therapy: Dilation
Disease management
Drug therapy
Eosinophilic esophagitis
Glucocorticoids: Proton pump inhibitors
Resumen

La esofagitis eosinofílica es una forma particular de alergia alimentaria no mediada por IgE caracterizada por infiltración esofágica por eosinófilos. Su prevalencia ha crecido hasta representar actualmente la primera causa de disfagia e impactación alimentaria en niños y adultos jóvenes. Evitar los alimentos causantes es el único tratamiento dirigido al origen de la enfermedad, pero ninguna prueba de alergia predice el alimento desencadenante. Las estrategias basadas en la eliminación empírica de alimentos resultan las más eficaces y convenientes en la práctica clínica. Los inhibidores de la bomba de protones constituyen un tratamiento de primera línea efectiva en la mitad de los pacientes, mediante un efecto antiinflamatorio directo independiente de su acción sobre la secreción ácida gástrica. Los glucocorticoides tópicos budesonida y fluticasona reducen la inflamación eosinofílica y revierten los síntomas. Esta revisión recoge los aspectos más relevantes de la epidemiología, diagnóstico, tratamiento y monitorización de la esofagitis eosinofílica.

Palabras clave:
Dietoterapia: Dilatación
Manejo de la enfermedad
Tratamiento farmacológico
Esofagitis eosinofílica
Glucocorticoides: Inhibidores de la bomba de protones

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