Esofagite eosinofila

Si tratta di una patologia di recente identificazione, di cui i primi casi sono stati descritti tra il 1960 ed il 1970.

È più frequente nei maschi adulti, ma comuni sono diagnosi in età pediatrica e l'incidenza, attualmente stimata in 5-10 casi su 100000 persone, pare essere in aumento.

La localizzazione tipica è la mucosa esofagea ed i granulociti eosinofili sono tipicamente presenti in quantità elevata.

Comune è l'associazione con altre patologie del sistema immunitario, quali, ad esempio, la rinite, l'asma, la colite eosinofila, la celiachia e la tiroidite.
 

Cause

L'elemento caratteristico è una infiammazione cronica della mucosa esofagea, nella quale sono presenti, in numero elevato, granulociti eosinofili, espressione di una alterazione del sistema immunitario che, a contatto con fattori ambientali poco definiti, risponde in maniera anomala, probabilmente su predisposizione genetica.

Sintomi

Il sintomo caratteristico è la disfagia e la difficoltà al transito del bolo alimentare o della saliva, associata a bruciore retrosternale e, a volte, dolore. I sintomi sono comuni ad altre patologie, quali ad esempi la malattia da reflusso gastroesofageo o le stenosi organiche, rendendo quindi la diagnosi difficile e spesso molto tardiva rispetto all'esordio dei sintomi.

Diagnosi

Fondamentale per la diagnosi è conoscere la malattia e porre il sospetto clinico in base ai sintomi.

Strumento essenziale è la gastroscopia con biopsie.

Esistono criteri morfologici endoscopici che permettono di formulare un punteggio, detto EREFS, utile anche nel monitoraggio della malattia e per valutare la risposta terapeutica, e criteri istologici basati sull'esame microscopico del tessuto prelevato mediante biopsie.

Il ruolo di altri strumenti diagnostici è trascurabile.

Rischi

Il mancato riconoscimento della malattia è il rischio più grande, perché non permette di somministrare una terapia adeguata ed efficace, ed espone il paziente alla possibilità di evoluzione della malattia verso gli stadi più avanzati e possibili complicanze, oltre che non permettere una soddisfacente qualità della vita per la sintomatologia non controllata.

Cure e Trattamenti

Posta correttamente la diagnosi, la terapia farmacologica permette di ottenere un buon controllo dei sintomi e arrestare l'evoluzione della malattia, che mantiene tuttavia in genere la sua caratteristica cronicità.

Gli inibitori di pompa protonica, omeprazolo e derivati hanno un ruolo, ma la maggior efficacia si ottiene con l'utilizzo di steroidi per via topica in dosaggi variabili.

Alcune indicazioni dietetiche possono avere qualche utilità e nuovi farmaci sono in via di sviluppo per controllare la malattia, agendo sul meccanismo di azione, ovvero sul sistema immunitario.

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