Esofagitis eosinofílica: estado del arte en 2024

Autores/as

DOI:

https://doi.org/10.22516/25007440.1276

Palabras clave:

Esofagitis eosinofilica, Esofagitis, Eosinofilia, Diagnóstico, Tratamiento

Resumen

La esofagitis eosinofílica es una enfermedad inmune y alérgica que está incluida en los desórdenes gastrointestinales eosinofílicos primarios. La incidencia y prevalencia han aumentado en las últimas décadas, así como la conciencia de esta enfermedad entre los gastroenterólogos. Es más frecuente en hombres jóvenes con antecedentes atópicos. Los criterios diagnósticos incluyen síntomas e histología de esófago con un recuento ≥15 eosinófilos/campo de alto poder o >60 eosinófilos/mm2, esta eosinofilia debe estar solo en el esófago y se deben descartar otras causas de eosinofilia. El tratamiento se basa en las 3 D: dieta, drogas y dilatación endoscópica. Se han aprobado nuevas terapias biológicas como dupilumab, y están en investigación novedosas estrategias terapéuticas para el manejo de esta enfermedad.

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Biografía del autor/a

Fabián Juliao-Baños, Hospital Pablo Tobón Uribe

Médico internista gastroenterólogo. Medellín, Colombia.

Adán Lúquez-Mindiola, Instituto de salud digestiva, GutMédica

Médico internista, gastroenterólogo. Bogotá, Colombia.

Referencias bibliográficas

Kay AB. The early history of the eosinophil. Clin Exp Allergy. 2015;45(3):575-82. https://doi.org/10.1111/cea.12480

Hua S, Cook D, Walker MM, Talley NJ. Pharmacological treatment of eosinophilic gastrointestinal disorders. Expert Rev Clin Pharmacol. 2016;9(9):1195-209. https://doi.org/10.1080/17512433.2016.1190268

Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978;74(6):1298-1301. https://doi.org/10.1016/0016-5085(78)90710-2

Winter HS, Madara JL, Stafford RJ, Grand RJ, Quinlan JE, Goldman H. Intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis. Gastroenterology. 1982;83(4):818-23. https://doi.org/10.1016/S0016-5085(82)80011-5

Attwood SE, Smyrk TC, Demeester TR, Jones JB. Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci. 1993;38(1):109-16. https://doi.org/10.1007/BF01296781

Straumann A, Spichtin HP, Bernoulli R, Loosli J, Vögtlin J. Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings. Schweiz Med Wochenschr. 1994;124(33):1419-29.

Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133(4):1342-63. https://doi.org/10.1053/j.gastro.2007.08.017

Hirano I. 2015 David Y. Graham Lecture: The First Two Decades Of Eosinophilic Esophagitis-From Acid Reflux To Food Allergy. Am J Gastroenterol. 2016;111(6):770-6. https://doi.org/10.1038/ajg.2016.136

Hahn JW, Lee K, Shin JI, Cho SH, Turner S, Shin JU, et al. Global Incidence and Prevalence of Eosinophilic Esophagitis, 1976-2022: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2023;21(13):3270-3284.e77. https://doi.org/10.1016/j.cgh.2023.06.005

Muir A, Falk GW. Eosinophilic Esophagitis: A Review. JAMA. 2021;326(13):1310-1318. https://doi.org/10.1001/jama.2021.14920

Biedermann L, Straumann A. Mechanisms and clinical management of eosinophilic oesophagitis: an overview. Nat Rev Gastroenterol Hepatol. 2023;20(2):101-119. https://doi.org/10.1038/s41575-022-00691-x

Kapel RC, Miller JK, Torres C, Aksoy S, Lash R, Katzka DA. Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups. Gastroenterology. 2008;134(5):1316-21. https://doi.org/10.1053/j.gastro.2008.02.016

Dellon ES, Hirano I. Epidemiology and Natural History of Eosinophilic Esophagitis. Gastroenterology. 2018;154(2):319-332.e3. https://doi.org/10.1053/j.gastro.2017.06.067

Jurado Zambrano LF, Arroyave-Benavides J, Jiménez-Uribe AM, Vera-Chamorro JF, Zambrano-Pérez CA, López-Panqueva RP. Caracterización clínico-patológica de la esofagitis eosinofílica en niños y adolescentes en el Hospital Universitario Fundación Santa Fe de Bogotá. Rev Colomb Gastroenterol. 2019;34(1):23-30. https://doi.org/10.22516/25007440.264

Juliao-Baños F, Lúquez-Mindiola A, Gómez-Venegas A, Parra-Izquierdo V, Marulanda-Fernández H, Carvajal-Gutiérrez J, et al. Características clínicas, sociodemográficas y tratamiento de la esofagitis eosinofílica en población adulta en Colombia. 2024; in press.

Alexander ES, Martin LJ, Collins MH, Kottyan LC, Sucharew H, He H, et al. Twin and family studies reveal strong environmental and weaker genetic cues explaining heritability of eosinophilic esophagitis. J Allergy Clin Immunol. 2014;134(5):1084-1092.e1. https://doi.org/10.1016/j.jaci.2014.07.021

Peterson K, Clayton F, Qeadan F, Gorman D, Robson J, Allen-Brady K, et al. Esophageal Eosinophilia Is Common Among Relatives of Eosinophilic Esophagitis Patients. Clin Gastroenterol Hepatol. 2022;20(5):e957-e963. https://doi.org/10.1016/j.cgh.2020.11.023

Ryu S, Lee KH, Tizaoui K, Terrazzino S, Cargnin S, Effenberger M, et al. Pathogenesis of Eosinophilic Esophagitis: A Comprehensive Review of the Genetic and Molecular Aspects. Int J Mol Sci. 2020;21(19):7253. https://doi.org/10.3390/ijms21197253

Pulendran B, Artis D. New paradigms in type 2 immunity. Science. 2012;337(6093):431-5. https://doi.org/10.1126/science.1221064

Arias Á, Lucendo AJ. Molecular basis and cellular mechanisms of eosinophilic esophagitis for the clinical practice. Expert Rev Gastroenterol Hepatol. 2019;13(2):99-117. https://doi.org/10.1080/17474124.2019.1546120

O’Shea KM, Aceves SS, Dellon ES, Gupta SK, Spergel JM, Furuta GT, et al. Pathophysiology of Eosinophilic Esophagitis. Gastroenterology. 2018;154(2):333-345. https://doi.org/10.1053/j.gastro.2017.06.065

Simon D, Cianferoni A, Spergel JM, Aceves S, Holbreich M, Venter C, et al. Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity. Allergy. 2016;71(5):611-20. https://doi.org/10.1111/all.12846

Lee SY, Nahm JH, Kim MJ, Kim Y, Kim JH, Youn YH, et al. Expression of Immunoglobulin G4 in Eosinophilic Esophagitis. J Clin Med. 2024;13(8):2175. https://doi.org/10.3390/jcm13082175

Gómez-Aldana A, Jaramillo-Santos M, Delgado A, Jaramillo C, Lúquez-Mindiola A. Eosinophilic esophagitis: Current concepts in diagnosis and treatment. World J Gastroenterol. 2019;25(32):4598-4613. https://doi.org/10.3748/wjg.v25.i32.4598

Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155(4):1022-1033.e10.

Dellon ES, Irani AM, Hill MR, Hirano I. Development and field testing of a novel patient-reported outcome measure of dysphagia in patients with eosinophilic esophagitis. Aliment Pharmacol Ther. 2013;38(6):634-42. https://doi.org/10.1111/apt.12413

Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut. 2013;62(4):489-95. https://doi.org/10.1136/gutjnl-2011-301817

Aceves SS, Alexander JA, Baron TH, Bredenoord AJ, Day L, Dellon ES, et al. Endoscopic approach to eosinophilic esophagitis: American Society for Gastrointestinal Endoscopy Consensus Conference. Gastrointest Endosc. 2022;96(4):576-592. https://doi.org/10.1016/j.gie.2022.05.013

Collins MH, Martin LJ, Alexander ES, Boyd JT, Sheridan R, He H, et al. Newly developed and validated eosinophilic esophagitis histology scoring system and evidence that it outperforms peak eosinophil count for disease diagnosis and monitoring. Dis Esophagus. 2017;30(3):1-8. https://doi.org/10.1111/dote.12470

Dellon ES, Khoury P, Muir AB, Liacouras CA, Safroneeva E, Atkins D, et al. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology. 2022;163(1):59-76. https://doi.org/10.1053/j.gastro.2022.03.025

Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995;109(5):1503-12. https://doi.org/10.1016/0016-5085(95)90637-1

Rank MA, Sharaf RN, Furuta GT, Aceves SS, Greenhawt M, Spergel JM, et al. Technical Review on the Management of Eosinophilic Esophagitis: A Report From the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters. Gastroenterology. 2020;158(6):1789-1810.e15. https://doi.org/10.1053/j.gastro.2020.02.039

Mayerhofer C, Kavallar AM, Aldrian D, Lindner AK, Müller T, Vogel GF. Efficacy of Elimination Diets in Eosinophilic Esophagitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2023;21(9):2197-2210.e3. https://doi.org/10.1016/j.cgh.2023.01.019

Kliewer KL, Gonsalves N, Dellon ES, Katzka DA, Abonia JP, Aceves SS, et al. One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial. Lancet Gastroenterol Hepatol. 2023;8(5):408-421. https://doi.org/10.1016/S2468-1253(23)00012-2

Liacouras CA, Wenner WJ, Brown K, Ruchelli E. Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr. 1998;26(4):380-5. https://doi.org/10.1097/00005176-199804000-00004

Główczewski A, Krogulska A. Formulations of Topical Steroids in Eosinophilic Esophagitis-Current Treatment and Emerging Possibilities. J Clin Med. 2022;11(5):1454. https://doi.org/10.3390/jcm11051454

Franciosi JP, Mougey EB, Dellon ES, Gutierrez-Junquera C, Fernandez-Fernandez S, Venkatesh RD, et al. Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: History, Mechanisms, Efficacy, and Future Directions. J Asthma Allergy. 2022;15:281-302. https://doi.org/10.2147/JAA.S274524

Muftah M, Goldin AH, Barshop K, Hsu Blatman K, Hamilton MJ, Lo WK, et al. Twice-Daily Proton Pump Inhibitor Induces Higher Remission Rate in Eosinophilic Esophagitis Than Once-Daily Regimen Regardless of Total Daily Dose. Am J Gastroenterol. 2024;119(5):991-995. https://doi.org/10.14309/ajg.0000000000002712

Gómez-Torrijos E, García-Rodríguez R, Castro-Jiménez A, Rodríguez-Sanchez J, Méndez Díaz Y, Molina-Infante J. The efficacy of step-down therapy in adult patients with proton pump inhibitor-responsive oesophageal eosinophilia. Aliment Pharmacol Ther. 2016;43(4):534-40. https://doi.org/10.1111/apt.13496

Odiase E, Zhang X, Chang Y, Nelson M, Balaji U, Gu J, et al. In Esophageal Squamous Cells From Eosinophilic Esophagitis Patients, Th2 Cytokines Increase Eotaxin-3 Secretion Through Effects on Intracellular Calcium and a Non-Gastric Proton Pump. Gastroenterology. 2021;160(6):2072-2088.e6. https://doi.org/10.1053/j.gastro.2021.02.016

Ishimura N, Ishihara S, Kinoshita Y. Sustained Acid Suppression by Potassium-Competitive Acid Blocker (P-CAB) May Be An Attractive Treatment Candidate for Patients with Eosinophilic Esophagitis. Am J Gastroenterol. 2016;111(8):1203-4. https://doi.org/10.1038/ajg.2016.167

Kuzumoto T, Tanaka F, Sawada A, Nadatani Y, Otani K, Hosomi S, et al. Vonoprazan shows efficacy similar to that of proton pump inhibitors with respect to symptomatic, endoscopic, and histological responses in patients with eosinophilic esophagitis. Esophagus. 2021;18(2):372-379. https://doi.org/10.1007/s10388-020-00783-0

Harb H, Chatila TA. Mechanisms of Dupilumab. Clin Exp Allergy. 2020;50(1):5-14. https://doi.org/10.1111/cea.13491

Dellon ES, Rothenberg ME, Collins MH, Hirano I, Chehade M, Bredenoord AJ, et al. Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med. 2022;387(25):2317-2330. https://doi.org/10.1056/NEJMoa2205982

Chehade M, Dellon ES, Spergel JM, Collins MH, Rothenberg ME, Pesek RD, et al. Dupilumab for Eosinophilic Esophagitis in Patients 1 to 11 Years of Age. N Engl J Med. 2024;390(24):2239-2251. https://doi.org/10.1056/NEJMoa2312282

Straumann A, Conus S, Grzonka P, Kita H, Kephart G, Bussmann C, et al. Anti-interleukin-5 antibody treatment (mepolizumab) in active eosinophilic oesophagitis: a randomised, placebo-controlled, double-blind trial. Gut. 2010;59(1):21-30. https://doi.org/10.1136/gut.2009.178558

Spergel JM, Rothenberg ME, Collins MH, Furuta GT, Markowitz JE, Fuchs G 3rd, et al. Reslizumab in children and adolescents with eosinophilic esophagitis: results of a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2012;129(2):456-63, 463.e1-3. https://doi.org/10.1016/j.jaci.2011.11.044

Rothenberg ME, Dellon ES, Collins MH, Bredenoord AJ, Hirano I, Peterson KA, et al. Eosinophil Depletion with Benralizumab for Eosinophilic Esophagitis. N Engl J Med. 2024;390(24):2252-2263. https://doi.org/10.1056/NEJMoa2313318

Dellon ES, Kim HP, Sperry SL, Rybnicek DA, Woosley JT, Shaheen NJ. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc. 2014;79(4):577-85.e4. https://doi.org/10.1016/j.gie.2013.10.027

Schoepfer AM, Safroneeva E, Bussmann C, Kuchen T, Portmann S, Simon HU, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology. 2013;145(6):1230-6.e1-2. https://doi.org/10.1053/j.gastro.2013.08.015

Schoepfer AM, Henchoz S, Biedermann L, Schreiner P, Greuter T, Reinhard A, et al. Technical feasibility, clinical effectiveness, and safety of esophageal stricture dilation using a novel endoscopic attachment cap in adults with eosinophilic esophagitis. Gastrointest Endosc. 2021;94(5):912-919.e2. https://doi.org/10.1016/j.gie.2021.05.017

Moawad FJ, Molina-Infante J, Lucendo AJ, Cantrell SE, Tmanova L, Douglas KM. Systematic review with meta-analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis. Aliment Pharmacol Ther. 2017;46(2):96-105. https://doi.org/10.1111/apt.14123

Sauer BG, Barnes BH, McGowan EC. Strategies for the Use of Dupilumab in Eosinophilic Esophagitis. Am J Gastroenterol. 2023;118(5):780-783. https://doi.org/10.14309/ajg.0000000000002206

Oliva S, Aceves SS, Zevit N, Rothenberg ME, Furuta GT, Dellon ES. Crafting a Therapeutic Pyramid for Eosinophilic Esophagitis in the Age of Biologics. Clin Gastroenterol Hepatol. 2024;22(9):1763-1769. https://doi.org/10.1016/j.cgh.2024.04.020

Visaggi P, Barberio B, Del Corso G, de Bortoli N, Black CJ, Ford AC, et al. Comparison of drugs for active eosinophilic oesophagitis: systematic review and network meta-analysis. Gut. 2023;72(11):2019-2030. https://doi.org/10.1136/gutjnl-2023-329873

Sorge A, Coletta M, Elli L, Bredenoord AJ. Clinical practices and adherence to guidelines for eosinophilic esophagitis: A European survey. Dig Liver Dis. 2024;56(7):1196-1203. https://doi.org/10.1016/j.dld.2023.12.011

Arnim UV, Biedermann L, Aceves SS, Bonis PA, Collins MH, Dellon ES, et al. Monitoring Patients With Eosinophilic Esophagitis in Routine Clinical Practice - International Expert Recommendations. Clin Gastroenterol Hepatol. 2023;21(10):2526-2533. https://doi.org/10.1016/j.cgh.2022.12.018

Figura 1. Fisiopatología de la esofagitis eosinofílica. Ba: basófilos; CAPN14: calpaína 14; DSG1: desmogleína 1; EE: epitelio esofágico; Eo: eosinófilos; FB: fibroblastos; IL: interleucina; Ma: mastocitos; NK: células asesinas naturales; PO: periostina; STAT 6: transductor de señal y activador de transcripción 6; TGFβ1: factor de crecimiento transformante beta 1; Th 2: T helper tipo 2; TSLP: linfopoyetina estromal tímica; TSLPr: receptor de linfopoyetina estromal tímica. Modificada de: Gómez-Aldana A, et al. World J Gastroenterol. 2019;25(32):4598-4613(24).

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2024-12-23

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Juliao Baños, F., & Lúquez Mindiola, A. (2024). Esofagitis eosinofílica: estado del arte en 2024. Revista Colombiana De Gastroenterología, 39(4), 435–446. https://doi.org/10.22516/25007440.1276

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