嗜酸性食管炎的饮食治疗策略

文献信息

中文摘要

嗜酸性食管炎（EoE）是一种慢性、免疫介导、非IgE介导的食物过敏，是成人吞咽困难和食物嵌顿的主要原因，全球患病率不断上升。诊断需要在排除其他胃肠道嗜酸性粒细胞增多原因后，食管活检显示每高倍视野≥15个嗜酸性粒细胞。食物过敏原，主要是牛奶、小麦、鸡蛋、豆类和海鲜，驱动炎症过程，治疗选择包括质子泵抑制剂、局部皮质类固醇、生物制剂以及针对狭窄性疾病的内镜下扩张。其中，饮食治疗是唯一去除致病触发因素而非抑制炎症反应的方法，使无药物持续缓解成为可能。要素饮食可实现最高的组织学缓解率，但在实践中耐受性差；经验性消除采用逐步升级策略，从一种或两种食物开始，在无反应时升级，对大多数成人更实用。传统过敏测试无法可靠识别EoE中的食物触发因素，不推荐用于此目的。重新引入触发食物会导致复发，因此长期依从性至关重要，并非所有患者都适合：重复内镜检查、饮食限制、生活质量影响以及回避/限制性食物摄入障碍（ARFID）风险是在推荐此方法前必须权衡的障碍。本综述总结了成人和青少年EoE可用的饮食方法，涵盖经验性消除策略及其疗效、过敏测试指导的饮食、患者选择、饮食与其他治疗的作用，以及营养充足性和依从性。

英文摘要

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated, non-IgE-mediated food allergy and a leading cause of dysphagia and food impaction in adults, with rising prevalence worldwide. Diagnosis requires ≥15 eosinophils per high-power field on esophageal biopsy after exclusion of other causes of gastrointestinal eosinophilia. Food allergens, principally milk, wheat, eggs, legumes and seafood, drive the inflammatory process, and treatment options include proton pump inhibitors, topical corticosteroids, biologic agents and endoscopic dilation for stricturing disease. Among these, dietary therapy is the only approach that removes the causative trigger rather than suppressing the inflammatory response, making drug-free, sustained remission achievable. Elemental diets achieve the highest histological remission rates but are poorly tolerated in practice; empiric elimination following a step-up strategy, starting with one or two foods and escalating in the absence of response, is more practical for most adults. Conventional allergy testing cannot reliably identify food triggers in EoE and is not recommended for this purpose. Reintroduction of the trigger food leads to relapse, making long-term adherence essential, and not all patients are suitable candidates: repeated endoscopy, dietary restriction, quality of life impact and the risk of avoidant restrictive food intake disorder (ARFID) are barriers that must be weighed before recommending this approach. This review summarizes the available dietary approaches in adult and adolescent EoE, covering empiric elimination strategies and their efficacy, allergy test-directed diets, patient selection, the role of diet alongside other treatments, and nutritional adequacy and adherence.