Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_936_Библиотеки_им_академика_М_И_Перельмана

Eosinophilic esophagitis (EE) was once considered to be a finding of GERD but has now risen from near obscurity to become the most common cause of esophageal food impaction in children and adults (Furuta & Katzka, 2015; Winter et al., 1982). A retrospective review noted that EE was diagnosed in 35% of foreign body/food impac­tions necessitating urgent endoscopic intervention (David et al., 2017). The exact etiology of EE remains unknown but is believed to be atopic in nature. Typical presenting symptoms include dysphagia and/or odynophagia unre­sponsive to antireflux medication. Most individuals have a prior history of allergic rhinitis, eczema, or asthma. Endoscopy may reveal a corrugated, ringed, or trachealized esophagus, and esophageal strictures are common (Fig­ure 15–8). The mucosa can often look normal, so it is important to biopsy an esophagus of ordinary appearance in an individual with dysphagia and no other apparent cause. The diagnosis is made by demonstrating >20 eosino­phils per high-powered field on esoph­ageal biopsy. Treatments with topical and systemic corticosteroids, montelu­kast, PPIs, histamine antagonists, and cromolyn sodium have all shown vary­ing degrees of success. Esophageal dila­tion may occasionally be necessary, but it should be performed with caution as the mucosa is often extremely friable (easily torn, fragile) with an increased risk of perforation and laceration.