Анонс:
Цель:
Ознакомить практикующих врачей с диагностикой и лечением эозинофильного эзофагита.
Основные положения.
Эозинофильный эзофагит (ЭоЭ) — это хроническое иммуноопосредованное заболевание пищевода, характеризующееся симптомами эзофагеальной дисфункции и выраженной эозинофильной инфильтрацией слизистой оболочки органа.
Диагностика ЭоЭ основывается на
- · данных клинической картины заболевания (дисфагия, эпизоды вклинения пищи в пищевод, боль в грудной клетке без связи с глотанием), а также
- · на совокупности эндоскопических и гистологических признаков.
Критерием установления диагноза служит эозинофильная инфильтрация слизистой оболочки пищевода с плотностью эозинофилов ≥ 15 в поле зрения микроскопа при большом увеличении (×400) по крайней мере в одном из биоптатов (около 60 эозинофилов в мм2).
Вспомогательное значение для диагноза имеют:
- · исследование общего IgE,
- · эозинофилия периферической крови,
- · результаты кожных аллергопроб
Для лечения ЭоЭ используется несколько подходов, включающих применение
- · ингибиторов протонной помпы (ИПП),
- · топических глюкокортикостероидов (ГКС), а также
- · элиминационные диеты.
Выбор терапии должен быть индивидуализированным, с обязательной оценкой эффективности инициального курса через 6–12 недель при эзофагогастродуоденоскопии с забором биоптатов.
Эндоскопическая дилатация должна рассматриваться у пациентов, страдающих выраженной дисфагией на фоне сужения пищевода.
Заключение.
Рост заболеваемости ЭоЭ в сочетании с преимущественным поражением детей и лиц молодого возраста, хроническое течение заболевания с необходимостью длительной поддерживающей терапии делают ЭоЭ значимой проблемой гастроэнтерологической практики.
Список литературы:
Литература / References
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