Análisis de las bases fisiopatogénicas y revisión sistemática del tratamiento de la esofagitis eosinofílica en pacientes refractarios

Abstract

Eosinophilic esophagitis (EoE) is a chronic disease of unknown ethiology, presenting a dense infiltration of eosinophils suggesting an association with allergy after exposure to inhaled or ingested allergens. By endoscopy, structural changes can be observed and esophagus caliber variations. Elimination diets and steroids are able to control symptoms and histological lesions and are used as firstline therapies; however, log-term treated patients often show potential serious adverse events and no or limited response. Hence, experimental biological therapies are currently being investigated. Aim: Firstly, to carry out a comprehensive review of symptoms, diagnoses and pathogenesis mechanisms of EoE. Secondly, to systematically review (SR) the current status of new biological treatments in refractory patients and to assess the value of an inflammatory activity score for EoE monitoring. Methods: Patients with EoE (n=25) and controls with gastric acid reflux (n=21) were analyzed. For the SR, publications (for experimental therapies and activity score data) were identified through electronic searches combining MeSH terms and specific key words. Relevant articles were identified against the selection criteria. Results: Most patients (96%) were male, mean age 36 years, presenting with dysphagia. A total of 639 patients, adults and children, with EoE were reassessed after therapy. Both, clinical (61%) and histological (58%) remissions were reported generally as low; in addition, only reduced levels of eosinophils in peripheral blood correlated with disease activity. Conclusions: The efficacy of new biological therapies was estimated poor, and it is generally accepted that more extensive, controlled studies are needed to know the exact efficacy and safety of these experimental second-line treatments for EoE refractory patients.