Kliničke smjernice za dijagnostiku, liječenje i praćenje bolesnika s eozinofilnim ezofagitisom*

Professional paper - Professional paper

• Title (english): Clinical guidelines for diagnosis, management and follow-up of patients with eosinophilic esophagitis*
• Author: Marija Milićević
• Author: Pave Markoš
• Author: Darija Vranešić Bender
• Author: Damir Aličić
• Author: Marko Banić
• Author: Neven Barišić
• Author: Ivan Bogadi
• Author: Mirjana Kalauz
• Author: Goran Poropat
• Author: Rosana Troskot Perić
• Author: Željko Krznarić; MBZ: 75865
• Author's institution: University of Zagreb; School of Medicine; (Department of Internal Medicine)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract (croatian)

Eozinofilni ezofagitis je kronična bolest posredovana putem Th2 obrasca imunosne reakcije, karakterizirana prisutnošću predominatno eozinofilnih upalnih promjena u jednjaku. Bolest je posredovana imuno/antigenim patofizološkim putem, a za definiciju bolesti potrebno je prisustvo kliničkih simptoma i histoloških elemenata bolesti. Unatrag desetak godina bilježi se porast incidencije i prevalencije EoE, gdje prevalencija EoE varira, te u
općoj populaciji iznosi 0,2–4/1000 u asimptomatskih bolesnika, dok kod simptomatskih bolesnika ona iznosi 5–6%. Smatra se da prevalencija u općoj populaciji iznosi 43 do 52/100000. Patofiziološki riječ je o poligenskoj bolesti u kojoj određeni citokini (IL-4, IL-5,IL-13, IL-14, TGF-β) igraju ključnu ulogu aktivirajući eotaksin-3 u sluznici jednjaka. Eotaksin-3 snažno privlači eozinofile u sluznicu jednjaka, a tako aktivirani eozinofili dovode do privlačenja drugih upalnih stanica, oslobađanja medijatora i nastanka bolesti. Histološki kriterij dijagnoze EoE je prisutnost više od 15 eozinofila prisutnih u vidnom polju bioptata sluznice jednjaka. Klinički, bolest se može manifestirati spektrom simptoma, od akutne impakcije hrane, disfagije, boli u žličici i žgaravice, a i nespecifični simptomi poput inapetencije ili povraćanja također se javljaju kod ovih bolesnika. Osnova liječenja ovih bolesnika
temelji se na medikamentnom liječenju, dijetalnim preporukama i endoskopskoj dilataciji. Cilj ovih kliničkih smjernica jest prikazati preporučeni algoritam dijagnostike i liječenja eozinofilnog ezofagitisa.

Abstract (english)

Eosinophilic esophagitis is a chronic, Th2-mediated disease characterized by the presence of predominantly eosinophilic inflammation in the esophagus. The disease is mediated by an immune or antigenic pathophysiological background, and the definition of the disease requires the presence of clinical symptoms and histological elements of the disease. Over the past ten years, there has been an increase in the incidence and prevalence of EoE, where the prevalence of EoE varies, and in the general population is 0.2–4 / 1000 in asymptomatic patients, while in symptomatic patients it is 5–6%. The prevalence in the general population is considered to be 43 to 52/100000. Pathophysiologically, it is a polygenic disease in which certain cytokines (IL-4, IL-5, IL-13, IL-14 and TGF-β) play a key role by activating eotaxin-3 in the esophageal mucosa. Eotaxin-3 strongly attracts eosinophils into the esophageal mucosa, and thus activated eosinophils lead to the attraction of other inflammatory cells, the release of mediators and the onset of disease. The histological criterion for the diagnosis of EoE is the presence of more than 15 eosinophils present in the visual field of esophageal mucosal biopsies. Clinically, the disease can manifest itself by a spectrum of symptoms, from acute food impaction, dysphagia, epigastric pain and heartburn, and nonspecific symptoms such as incontinence or vomiting also occur in these patients. The basis of treatment of these patients is based on drug therapy, dietary recommendations and endoscopic dilatation. Thea im of these clinical recommendations is to present the pathway of diagnosis and
therapy of eosinophilic esophagitis.

• Keywords (croatian): EOZINOFILNI EZOFAGITIS – dijagnoza, patofiziologija, patologija, liječenje; SLUZNICA JEDNJAKA – patologija; EOZINOFILI – patologija; EZOFAGOSKOPIJA; GLUKOKORTIKOIDI – terapijska uporaba; INHIBITORI PROTONSKE PUMPE – terapijska uporaba; DIJETOTERAPIJA – metode; STENOZA JEDNJAKA – liječenje; DILATACIJA – metode; TH2 STANICE – imunologija; CITOKINI – imunologija; PREPORUKE; SMJERNICE
• Keywords (english): EOSINOPHILIC ESOPHAGITIS – diagnosis, pathology, physiopathology, therapy; ESOPHAGEAL MUCOSA – pathology; EOSINOPHILS – pathology; ESOPHAGOSCOPY; GLUCOCORTICOIDS – therapeutic use; INHIBITORS PROTON PUMP – therapeutic use; DIET THERAPY – methods; ESOPHAGEAL STENOSIS – therapy; DILATATION – methods; DIET THERAPY – methods; TH2 CELLS – immunology; CYTOKINES – immunology; ALGORITHMS; PRACTICE GUIDELINES AS TOPIC
• Language: croatian
• Language: english
• Publication type: Professional paper - Professional paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Liječnički vjesnik
• Numbering: vol. 144, no. 1-2, pp. 15-31
• p-ISSN: 0024-3477
• e-ISSN: 1849-2177
• DOI: https://doi.org/10.26800/LV-144-1-2-2
• URN:NBN: urn:nbn:hr:105:595221
• Publication: 2022
• Document URL: https://hrcak.srce.hr/272010
• Type of resource: Text
• Access conditions: Open access
• Public note: * Kliničke smjernice Hrvatskog društva za kliničku prehranu Hrvatskoga liječničkog zbora, Hrvatskog društva za imunologiju sluznice Hrvatskoga liječničkog zbora, Hrvatskoga gastroenterološkog društva te Hrvatskog društva nutricionista i dijetetičara / Clinical recommendations of Croatian Society of Clinical Nutrition, Croatian Medical Association, Croatian Society of Mucosal Immunity Croatian Medical Association, Croatian Society of Gastroenterology and Croatian Society of Nutritionists and Dietitians
• Created on: 2022-05-23 10:36:23