La prise en charge médicale de l’oesophagite à éosinophiles
Résumé
L’oesophagite à éosinophiles (OeE) a été pour la première fois reconnue en tant qu’entité distincte au début des années 1990. Elle a été décrite par Alex Straumann qui avait identifié 10 enfants présentant des « symptômes de reflux gastro-oesophagien (RGO) » résistants avec caractéristiques endoscopiques typiques et éosinophilie oesophagienne, et chez qui les symptômes tout comme l’éosinophilie oesophagienne avaient disparu avec une formulation diététique élémentaire. Alors qu’autrefois l’OeE était une maladie rare, elle est de plus en plus diagnostiquée dans le monde, avec un taux d’incidence estimé entre 5 et 10 pour 100 000 individus. Bien qu’elle soit largement considérée comme un trouble inflammatoire de type Th-2, parfois déclenché par des allergènes alimentaires, un nombre croissant de publications évoquent le rôle des aéroallergènes dans cette maladie. La prise en charge de la maladie demande une étroite collaboration entre les spécialistes de la gastro-entérologie et de l’allergie. Au moins la moitié des patients qui en sont atteints souffrent d’autres troubles allergiques, notamment de rhinite allergique, d’asthme, d’eczéma, et certains présentent également des allergies alimentaires à médiation IgE. L’évaluation et la prise en charge des sensibilités aux aéroallergènes sont essentielles, car l’ingestion d’aéroallergènes peut être un facteur contributif de l’oesophagite à éosinophiles, et de nombreux patients remarquent une exacerbation saisonnière de leurs symptômes.
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