Opciones de Tratamiento de Primera Línea para la Esofagitis Eosinofílica
Escenario Clínico
Este protocolo aborda el manejo inicial de pacientes con eosinofilia esofágica sintomática (EoE) que no han recibido tratamiento previo para esta condición.
Objetivo del Tratamiento
El objetivo primario es lograr la remisión histológica, definida como un recuento esofágico de eosinófilos inferior a 15 eosinófilos por campo de gran aumento, evaluada aproximadamente a las 8 semanas del inicio del tratamiento.
<15 eos/hpf a las ~8 semanas
Enfoque de Tratamiento (parcial)
El manejo de primera línea implica elegir entre varias alternativas al no tratamiento, que abarcan tanto estrategias farmacológicas como dietéticas — el protocolo estructurado completo detalla cada opción y la evidencia que la respalda.
References
DOI: 10.1053/j.gastro.2020.02.038
- In patients with symptomatic esophageal eosinophilia, the AGA/JTF suggests using proton pump inhibition over no treatment.
- In patients with EoE, the AGA/JTF recommends topical glucocorticosteroids over no treatment.
- Eight double-blind placebo-controlled studies enrolling 437 patients followed for a mean of 8 weeks compared treatment with topical budesonide or topical fluticasone to placebo.
- In patients with EoE, the AGA/JTF suggests using elemental diet over no treatment.
- In patients with EoE the AGA/JTF suggests using an empiric six-food elimination diet over no treatment.
- In patients with EoE, the AGA/JTF suggests allergy testing-based elimination diet over no treatment.
- With the exception of the recommendation on esophageal dilation, the guidelines are based on the failure to achieve histologic remission of <15 eosinophils/high power field (eos/hpf) as the definition of treatment effect.
- Until such metrics are established, a threshold of <15 eos/hpf to define an adequate therapeutic response serves as a response criterion until a better measure is established.
View source ↗