Bruno Queiroz Sander¹*, Christian Follador Melado², Helen Brum Barcellos³, Edson Portela⁴, Adilson Renato Veríssimo⁵, Aline Damasceno de Avance⁶, Guilherme Camarotti de Oliveira Canejo⁷, Flávio Rogério Hoerlle⁸, Tiago Alves de Moura⁹, Rolando Edward Marca Oliveira¹⁰, José Alberto da Silva¹¹, Joao Marcelo Guimarães Marques¹², Amanda Torres Coelho¹³, Paulo Ricardo Ramos Mendonça Filho¹⁴, Erson Ramires Alves Barbosa¹⁵, Lincoln Cruz Dantas¹⁶, Raielly Coutinho Barbosa¹⁷, Carlos Henrique Rodrigues Castro¹⁸, Felipe Antonio de Rezende¹⁹, Francisco Eduardo Moraes de Oliveira²⁰, Alexandre Salomão de Barros oliveira²¹, Leonardo Teixeira Rodrigues²² and Jonas Pinto Vieira²³

¹Sander Medical Center, Brazil
²TopMed, Brazil
³Gastrocirurgica- Clínica do Aparelho Digestivo, Brazil
⁴Hospital Portela, Brazil
⁵Universidade Federal de Juiz de Fora, Brazil
⁶Unifadra-Faculdade de Medicina de Dracena, Brazil
⁷Hospital da Unimed Caruaru, PE, Brazil
⁸Hospital de Caridade de Ijui-HCI, Brazil
⁹Hospital dos Acidentados, Brazil
¹⁰Hospital Regional de Extrema, Brazil
¹¹Saúde Center Clinica, Brazil
¹²Medic Gastro Center, Brazil
¹³UNIPAC, Brazil
¹⁴Hospital Regional Dom Moura /PÉ, Brazil
¹⁵UniClim São Miguel-RN, Brazil
¹⁶Clínica Dr. Lincoln Dantas, Brazil
¹⁷Universidade Federal do Amapá, Brazil
¹⁸Clínica São Francisco de Assis, Brazil
¹⁹Clínica Gastro Metropolitano, Serra, Espírito Santo, Brazil
²⁰Clínica Maria de Nazaré-Pimenta Bueno-RO, Brazil
²¹Clínica MediFisio, Brazil
²²Complexo hospitalar de Niterói, Brazil
²³Endomed Clínica Médica, Brazil

*Corresponding Author: Bruno Queiroz Sander, Sander Medical Center, Brazil.

Received: March 29, 2021; Published: April 15, 2021

Abstract

  Eosinophilic Esophagitis is a chronic, immunologically mediated pathology characterized by eosinophil infiltrates in the esophageal mucosa, causing dysfunction of the organ. It can affect any age group, being more common in young people and with other atopics such as asthma, food allergy and allergic rhinitis. The symptoms presented by the patient can range from manifestations of gastroesophageal reflux, abdominal pain, to dysphagia and food impaction. The diagnosis is made through upper digestive endoscopy with biopsies demonstrating eosinophilic infiltrate greater than 15 eosinophils per field. This article has as main theme the treatment of maintenance of eosinophilic esophagitis, aiming to contextualize medical professionals with the therapeutic options used and the impact on clinical improvement and histological remission. Theoretical research started from non-experimental methodology, through literature review on the subject in recent years. The practical guidelines for the therapy of Eosinophilic Esophagitis should involve multidisciplinary follow-up with specialized professionals, such as gastroenterologist, nutritionist and allergist, being based on pharmacological and dietary measures. Dietary treatment consists of the identification of specific food allergens through tests or the empirical elimination diet of potentially more allergenic food groups. Clinical management includes an initial course with proton pump inhibitors. Topical corticosteroids (Fluticasone or Budesonide) are medications capable of reducing the eosinophilic inflammatory response and inducing histological and clinical improvement. Systemic courses of oral corticosteroids, such as Prednisone, may be necessary in patients with significant symptomatology. Endoscopic treatment, through esophageal dilation, is indicated in cases of symptomatic esophageal stricture. The choice of therapy will depend on the clinical picture, the histological analysis and the reported symptoms, as well as the preference of the physician, the patient and the costs.

Keywords: Eosinophilic Esophagitis; Elimination Diet; Corticotherapy; Fluticasone; Budesonide; Esophageal Dilation

References

1. Gonçalves Lara de Oliveira. “Prevalence of Eosinophilia Esophagitis in pediatric patients undergoing upper gastrointestinal endoscopy”. 46f. Dissertation (Postgraduate Program) in Health Sciences. Federal University of Uberlândia. Uberlândia/MG (2017).
2. Daud Juliana Salomão. “Histopathological aspects of Eosinophilic Esophagitis in children and adolescents”. 59f. Thesis of the Postgraduate Program in Health Sciences. Federal University of Uberlândia. Uberlândia/MG (2017).
3. Ferreira Cristina Targa. “Eosinophilic esophagitis. In: IPEMED: Gastroenterology: themes to support graduate studies”. 1^st Belo Horizonte: Rona”. IPEMED Faculty of Medical Sciences (2017).
4. Manne S Yara Amaral. “Eosinophilic esophagitis”. In: Internal bulletin of the Department of Otorhinolaryngology, Hospital da Cruz Vermelha 3.1 (2013).
5. Nàpolis Ana Carolina Ramos de. “Eosinophilic esophagitis in patients with cerebral palsy”. 45f. Master Thesis of the Post-Graduate Program in Health Sciences. Federal University of Uberlândia”. Uberlândia/MG (2014).
6. Dellon Evan S., et al. “ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)”. The American Journal of Gastroenterology 108 (2013): 679-692.
7. Barros Cristina Palmer., et al. “Eosinophilic esophagitis”. In: Practical Update Guide. Scientific Department of Gastroenterology. São Paulo: SBP 2.3 (2018).
8. Couto Mariana., et al. “Eosinophilic esophagitis”. In: Acta Med (review article)”. Acta Med Portugal 24 (2011): 949-960.
9. Fey Augusto., et al. “Eosinophilic Esophagitis: Literature Review”. Revista ACM2 (2012): 89-92.
10. Gonçalves Valéria Botan. “Morphological parameters of peripheral blood eosinophil activation: a new tool for screening patients with eosinophilic esophagitis”. 151f. Postgraduate Doctoral Thesis in Molecular Pathology”. University of Brasilia/UNB. Brasília/DF (2015).
11. Sabrà Aderbal. “Eosinophilic esophagitis. Review article”. Journal of Food Allergy1 (2015): 1-19.
12. Domingues Gerson Ricardo de S., et al. “Eosinophilic Esophagitis: Diagnosis and treatment”. In: RBM magazine: Grupo Editorial Jr Moreira 1.4 (2017).
13. Dias Eduardo Montagner., et al. “Eosinophilic esophagitis: update and contribution of endoscopy”. In: Scientific Bulletin of Pediatrics 1.1 (2012): 19-28.
14. Rodriguez Tomás Navarro and SANTOS Ivanna Beserra. “Eosinophilic esophagitis”. In: Gastroenterology treaty: from undergraduate to graduate”. 3rd ed. São Paulo: Editora Atheneu (2017).
15. Almeida Virginia Brasil de. “Esophagitis and Esophageal Diseases: causes by diverticula, membranes and rings”. In: Gastroenterology and hepatology: from pathogenesis to management. 1^st Belo Horizonte: Rona. IPEMED Faculty of Medical Sciences (2017).
16. Epifânio Matias., et al. “Eosinophilic esophagitis in children. Review article”. In: Scientia Medica, Porto Alegre: PUCRS 16.4 (2016): 183-189.

Citation

Citation: Bruno Queiroz Sander., et al. “Maintenance Treatment of Eosinophilic Esophagitis”. Acta Scientific Gastrointestinal Disorders 4.5 (2021): 33-42.

Copyright

Copyright: © 2021 Bruno Queiroz Sander., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.