Eosinophilic esophagitis

Jovan Jevtić; Radmila  Janković

doi:10.5937/mp74-40267

Jovan Jevtić Institut za patologiju, Medicinski fakultet, Univerzitet u Beogradu
Radmila Janković Institut za patologiju “Prof. dr Đorđe Joannović”, Medicinski fakultet, Univerziteta u Beograd

DOI: https://doi.org/10.5937/mp74-40267

Ključne reči: eozinofilni ezofagitis, eozinofili, GERB, patologija

Sažetak

Eozinofilni ezofagitis (EoE) je inflamatorno stanje koje se karakteriše intraepitelnom eozinofilnom infiltracijom praćenom disfunkcijom jednjaka. Patofiziološki mehanizam EoE još nije dobro poznat, postoji nekoliko faktora koji učestvuju u patogenezi, kao što su imunitet domaćina, faktori životne sredine i genetski faktori. Savremena dijagnostika EoE treba da obuhvati: kliničke manifestacije (disfunkcija jednjaka), biopsiju jednjaka sa najmanje 15 eozinofila po polju velikog uveličanja i odsustvo druge patologije koju karakteriše povećan broj eozinofila. Najčešći simptomi kod odraslih su disfagija, gorušica, zastoj hrane u jednjaku i bol u grudima. Deca se obično prezentuju mučninom i povraćanjem, anoreksijom, gorušicom, regurgitacijom, pečenjem u grudima i bolovima u stomaku. Endoskopski, pacijente sa EoE karakterišu uzdužne brazde (vertikalne linije, tamnije od okolne sluzokože), trahealizacija jednjaka (brojni transverzalni prstenovi, kao kod traheje), eksudat (beli plakovi), edem (smanjena vaskularizacija sluzokože), strikture i “crepe-paper” sluzokoža (krhkost sluzokože i kidanje tokom endoskopije). Histološke karakteristike EoE mogu se podeliti na major i minor kriterijume. Major kriterijumi uključuju: intraepitelnu infiltraciju eozinofilima (>15 eozinofila/HPF), eozinofilne mikroapscese (≥ 4 eozinofila u kolekciji), eozinofile koji zauzimaju spoljašnji sloj skvamoznog epitela, ljuštenje epitela i degranulaciju eozinofila. Minor kriterijumi uključuju: hiperplaziju bazalne zone epitela jednjaka, produženje epitelnih papila, intracelularni edem i subepitelnu fibrozu. Da bi se postavila adekvatna dijagnoza, treba isključiti sva ostala stanja povezana sa povećanim brojem eozinofila. Najčešća i najvažnija diferencijalna dijagnoza je gastroezofagealna refluksna bolest (GERB). Lečenje EoE obuhvata: inhibitore protonske pumpe (PPI), kortikosteroide (lokalne i sistemske), eliminacionu dijetu i dilataciju jednjaka.

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