Nahrung als Trigger der eosinophilen Ösophagitis

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus with increasing incidence and prevalence. The etiology is multifactorial. In addition to genetic factors, environmental allergens in food or air play a crucial role. The most common food triggers of EoE are cow’s milk, wheat, egg, and soy. EoE is a non-IgE-mediated disease, which is why food triggers cannot be reliably identified by classical allergy tests. Due to epithelial barrier disruption, antigens enter the subepithelial space more easily and are recognized by antigen-presenting cells, whereupon a T_H2‑mediated immune response is triggered by the interleukins (IL) IL‑4, IL‑5, and IL-13. Thus, recruitment and activation of eosinophils, basophils, and mast cells occurs. Symptoms of EoE differ according to age: while the complaints in childhood are nonspecific, older children, adolescents, and adults report heartburn, difficulty swallowing, or bolus obstruction. The disease is diagnosed when a patient has > 15 eosinophils/high-power field in one of at least four biopsies and has clinical symptoms. The following therapeutic options are available for remission induction: proton pump inhibitors (PPI), elimination diet, topical steroids, and dupilumab (newly approved for adults and adolescents 12 years and older with bodyweight ≥ 40 kg). Endoscopic dilation should be performed in treatment-refractory symptomatic esophageal strictures. Antigen elimination by elimination diet is the only form of therapy that targets disease triggers. Treatment monitoring should include clinical symptoms and quality of life, as well as endoscopic findings with histology.