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App\Entity\Article {#528
  -id: 9
  -title: "Eosinophile Ösophagitis (EoE) – eine noch häufig übersehene Erkrankung der Speiseröhre"
  -teaser: "<p>Die eosinophile &Ouml;sophagitis (EoE) ist eine entz&uuml;ndliche Erkrankung der Speiser&ouml;hre. Sie entsteht durch eine allergie&auml;hnliche Reaktion bei Kontakt mit Allergenen, h&auml;ufig sind das bestimmte Nahrungsmittel.</p>"
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    <p>Die eosinophile &Ouml;sophagitis (EoE) ist eine entz&uuml;ndliche Erkrankung der Speiser&ouml;hre. Sie entsteht durch eine allergie&auml;hnliche Reaktion bei Kontakt mit Allergenen, h&auml;ufig sind das bestimmte Nahrungsmittel. Mit einer Pr&auml;valenz von 34 Patient*innen pro 100.000 Einwohnern geh&ouml;rt sie zu den seltenen Krankheiten. Dennoch ist sie die zweith&auml;ufigste entz&uuml;ndliche Erkrankung der Speiser&ouml;hre nach der gastro&ouml;sophagealen Refluxkrankheit (GERD). Die Zahl der von EoE betroffenen Patient*innen hat in den letzten 20 Jahren deutlich zugenommen.<sup>1</sup></p>\r\n
    \r\n
    <h2>Wie entsteht eine eosinophile &Ouml;sophagitis?</h2>\r\n
    \r\n
    <p>Die EoE ist eine Erkrankung, f&uuml;r deren Entstehung mehrere Faktoren eine Rolle spielen. Das k&ouml;nnen Umweltfaktoren, Allergene (z.B. Pollen, Hausstaubmilben, Nahrungsmittelallergene) und eine genetische Veranlagung sein. Der f&uuml;r die EoE charakteristischen Entz&uuml;ndung der Speiser&ouml;hre liegt eine Immunreaktion zugrunde, die sich von IgE-vermittelten Nahrungsmittelallergien unterscheidet. Mit dem &uuml;blicherweise zum Nachweis einer Allergie eingesetzten Prick-Test ist das f&uuml;r die EoE verantwortliche Allergen deshalb nicht zuverl&auml;ssig nachweisbar. Von einer routinem&auml;&szlig;igen Allergietestung bei Erwachsenen r&auml;t die Leitlinie deshalb ab.<sup>1,2,3</sup></p>\r\n
    \r\n
    <h2>Welche Symptome k&ouml;nnen auftreten?</h2>\r\n
    \r\n
    <p>Das Kardinalsymptom der EoE sind Schluckst&ouml;rungen (Dysphagie), 90% der Patient*innen sind davon betroffen. Dar&uuml;ber hinaus k&ouml;nnen aber auch Sodbrennen-&auml;hnliche Beschwerden, Brennen im Bereich hinter dem Brustbein und/oder Regurgitation (R&uuml;ckfluss von Speisebrei in den Mund) auftreten. Dar&uuml;ber hinaus kann das Essen im Hals stecken bleiben, sodass es zu Blockaden kommt.<sup>4</sup></p>\r\n
    \r\n
    <h2>Wie wird die EoE korrekt diagnostiziert?</h2>\r\n
    \r\n
    <h3>Der Ablauf der Diagnose</h3>\r\n
    \r\n
    <p>Einen ersten wichtigen Hinweis auf eine EoE geben die charakteristischen Symptome, die im Gespr&auml;ch mit der Patientin oder dem Patienten abgefragt werden, allen voran die Schluckst&ouml;rungen. Dabei ist zu bedenken, dass die Betroffenen oft schon lange an den Beschwerden leiden und Anpassungsstrategien entwickelt haben. Sie nehmen die Schluckbeschwerden nicht mehr als solche wahr. Hier gilt es gezielt, aber indirekt nachzufragen:<sup>4</sup></p>\r\n
    \r\n
    <p>- Brauchen Sie beim Essen l&auml;nger als andere?<br />\r\n
    - Schneiden Sie Ihr Essen sehr klein oder p&uuml;rieren Sie es?<br />\r\n
    - Bevorzugen Sie leicht rutschende Speisen (Brei, Pudding)?<br />\r\n
    - Meiden Sie das Essen in Gesellschaft?<br />\r\n
    - Trinken Sie nach jedem Bissen etwas nach?</p>\r\n
    \r\n
    <p>Da die EoE h&auml;ufig mit allergischen Erkrankungen vergesellschaftet ist, k&ouml;nnen Patient*innen au&szlig;erdem gefragt werden, ob sie bereits allergische Erkrankungen wie Asthma bronchiale oder eine Nahrungsmittelallergie haben.</p>\r\n
    \r\n
    <p>Dar&uuml;ber hinaus wird eine endoskopische Untersuchung der Speiser&ouml;hre durchgef&uuml;hrt. Typische Anzeichen einer EoE sind das Austreten wei&szlig;licher Fl&uuml;ssigkeit, L&auml;ngsfurchen, Schleimhautr&ouml;tungen, fixierte Ringe, eine kleinkalibrige Speiser&ouml;hre und Einengungen. Bei der Speiser&ouml;hrenspiegelung werden au&szlig;erdem mehrere Gewebeproben f&uuml;r die feingewebliche Untersuchung entnommen. Der histologische Befund ist f&uuml;r die Diagnose einer EoE zwingend notwendig, da bei manchen Patient*innen keine sichtbaren Ver&auml;nderungen der Speiser&ouml;hre vorliegen. Dar&uuml;ber hinaus m&uuml;ssen andere Erkrankungen ausgeschlossen werden.<sup>1</sup></p>\r\n
    \r\n
    <p>Die EoE wird bei vielen Patient*innen erst sp&auml;t erkannt. Zum Diagnosezeitpunkt weisen sie dann bereits Sp&auml;tfolgen wie Fibrosierung (Vernarbung), Verengungen der Speiser&ouml;hre durch Narbengewebe sowie funktionelle St&ouml;rungen wie Schluck-Blockaden auf.<sup>8</sup></p>\r\n
    \r\n
    <h3>Abgrenzung zur GERD</h3>\r\n
    \r\n
    <p>Die Symptome von GERD und EoE &uuml;berlappen sich teilweise, weshalb es wichtig ist, sorgf&auml;ltig zwischen den beiden Krankheiten zu unterscheiden: W&auml;hrend die EoE insbesondere bei &auml;lteren Jugendlichen und Personen zwischen 30 und 50 Jahren auftritt, kommt die GERD in allen Altersklassen &uuml;ber 20 Jahren gleich h&auml;ufig vor. Von einer EoE sind au&szlig;erdem h&auml;ufiger M&auml;nner betroffen und &Uuml;bergewicht spielt im Gegensatz zur GERD eine untergeordnete Rolle. Auch die Symptome geben einen wichtigen Hinweis: GERD-Patienten werden vor allem von Sodbrennen geplagt, w&auml;hrend es bei der EoE die Schluckbeschwerden sind. Und auch eine gleichzeitig bestehende atopische Erkrankung deutet eher auf eine EoE hin als auf eine GERD.<sup>1,7,9</sup></p>\r\n
    \r\n
    <h2>H&auml;ufig vergesellschaftet: Eosinophile &Ouml;sophagitis und Asthma bronchiale</h2>\r\n
    \r\n
    <p>Oft haben Patient*innen mit EoE zus&auml;tzlich eine Atopie. Das bedeutet, dass sie eine erbliche Veranlagung haben, bei Kontakt mit allergieausl&ouml;senden Stoffen (Allergenen) eine &uuml;bersteigerte Abwehrreaktion und allergische Erkrankungen wie Asthma bronchiale, Heuschnupfen oder Neurodermitis zu entwickeln. Die EoE z&auml;hlt selbst aber nicht zu den atopischen Erkrankungen, sie kann auch bei Menschen auftreten, die keine Allergien aufweisen.<sup>10</sup> Dennoch wird die EoE manchmal sogar als &bdquo;Asthma der Speiser&ouml;hre&ldquo; bezeichnet, denn es gibt gewisse Gemeinsamkeiten. Beide Erkrankungen zeichnen sich zum Beispiel durch (meist) allergiebedingte Entz&uuml;ndungen aus, bei der EoE ist davon die Speiser&ouml;hre betroffen, beim Asthma die Bronchien. Klinisch gibt es jedoch deutliche Unterschiede, vor allem bei der Symptomatik. Das Hauptsymptom der EoE sind die Schluckbeschwerden, beim Asthma bronchiale leiden die Patient*innen an Luftnot.<sup>1,11</sup></p>\r\n
    \r\n
    <h2>Therapie der EoE</h2>\r\n
    \r\n
    <p>Ein wichtiges Ziel der Therapie bei EoE ist die Kontrolle der Symptome, um die Lebensqualit&auml;t der Patient*innen zu verbessern. Dar&uuml;ber hinaus ist es von enormer Wichtigkeit, dass die &ouml;sophageale Entz&uuml;ndung abklingt, um Sp&auml;tfolgen zu verhindern. Denn unbehandelt kann die chronische Entz&uuml;ndung zu einem Umbau der Speiser&ouml;hre f&uuml;hren, Vernarbungen und Verengungen sind dann die Folge. Gem&auml;&szlig; der deutschen Leitlinie werden zur Therapie der EoE entweder topische Kortikosteroide oder Protonenpumpeninhibitoren (PPI) oder eine Eliminationsdi&auml;t empfohlen. Bei der Eliminationsdi&auml;t werden die Nahrungsmittel aus dem Speiseplan gestrichen, die am h&auml;ufigsten mit Nahrungsmittelallergien assoziiert sind: Kuhmilchproteine, Weizen, Soja, Ei, N&uuml;sse und Fisch/Meeresfr&uuml;chte. Als Therapie der ersten Wahl bei erwachsenen EoE-Patient*innen gelten heute topische Kortikosteroide.<sup>1</sup></p>\r\n
    \r\n
    <p>&nbsp;</p>\r\n
    \r\n
    <p><strong>Quellen:</strong></p>\r\n
    \r\n
    <ol>\r\n
    \t<li>S2k-Leitlinie Gastro&ouml;sophageale Refluxkrankheit und eosinophile &Ouml;sophagitis der Deutschen Gesellschaft f&uuml;r Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS).</li>\r\n
    \t<li>O&rsquo;Shea KM, Aceves SS, Dellon ES, Gupta SK, Spergel JM, Furuta GT et al. Pathophysiology of eosinophilic esophagitis. Gastroenterology 2018; 154(2):333&ndash;45.</li>\r\n
    \t<li>Simon D, Cianferoni A, Spergel JM, Aceves S, Holbreich M, Venter C et al. Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity. Allergy 2016; 71(5):611&ndash;20.</li>\r\n
    \t<li>Miehlke S. Clinical features of Eosinophilic esophagitis in children and adults. Best Pract Res Clin Gastroenterol. 2015 Oct;29(5):739&ndash;748.</li>\r\n
    \t<li>Schoepfer AM, Safroneeva E, Bussmann C. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology 2013 Dec;145(6):1230-6.e1-2.</li>\r\n
    \t<li>Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900&ndash;1943.</li>\r\n
    \t<li>Lucendo AJ, Molina-Infante J, Arias &Aacute;, von Arnim U, Bredenoord AJ, Bussmann C et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017; 5(3):335&ndash;58.</li>\r\n
    \t<li>Allergieinformationsdienst: Eosinophile Erkrankungen des Verdauungstrakts.</li>\r\n
    \t<li>S2k-Leitlinie zur fach&auml;rztlichen Diagnostik und Therapie von Asthma 2023.</li>\r\n
    </ol>
    """
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:71
Show trace 
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:72
Show trace 
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Symfony\Component\HttpKernel\DataCollector\RequestDataCollector:73
Show trace 
[
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Flashes

Flashes

Key Value
error 
[
  "Sie müssen eingeloggt sein um diesen Artikel lesen zu können!"
]

Server Parameters

Server Parameters

Defined in .env

Key Value
APP_ENV 
"dev"
APP_SECRET 
"a1d687c7188a8bbff1cb1e7504f8f22f"
DATABASE_URL 
"mysql://apofalk-academy:0az5otq1qeT1QVQK@127.0.0.1:3306/apofalk-academy"
GOOGLE_CAPTCHA_KEY 
"6LeMd_8qAAAAAIYtrI1v6HmANQgT4wNKYuMnDZ0c"
MAILER_DSN 
"smtp://apofalk@creatediv-ld.de:trU5MSwFK643w9o1@mail.your-server.de:587"
MAILER_NAME 
"apofalk.de"
MAILER_USER 
"info@creatediv.de"
MESSENGER_TRANSPORT_DSN 
"doctrine://default?auto_setup=0"
POINTS_FOR_ELEARNING 
"20"
POINTS_FOR_QUIZ 
"10"
POINTS_NEEDED_FOR_CLUB 
"60"
WKHTMLTOPDF_PATH 
"/usr/local/bin/wkhtmltopdf"

Defined as regular env variables

Key Value
APP_DEBUG 
"1"
CONTEXT_DOCUMENT_ROOT 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public"
CONTEXT_PREFIX 
""
DOCUMENT_ROOT 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public"
FCGI_ROLE 
"RESPONDER"
GATEWAY_INTERFACE 
"CGI/1.1"
HOME 
"/var/www/vhosts/dev-plesk.creatediv.local"
HTTP_ACCEPT 
"*/*"
HTTP_ACCEPT_ENCODING 
"gzip, br, zstd, deflate"
HTTP_CONNECTION 
"close"
HTTP_HOST 
"apofalk-academy.dev-plesk.creatediv.local"
HTTP_USER_AGENT 
"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)"
HTTP_X_ACCEL_INTERNAL 
"/internal-nginx-static-location"
HTTP_X_FORWARDED_FOR 
"216.73.216.96"
HTTP_X_FORWARDED_HOST 
"apofalk-academy.dev-creatediv.de"
HTTP_X_FORWARDED_SERVER 
"apofalk-academy.dev-creatediv.de"
HTTP_X_REAL_IP 
"192.168.20.3"
PATH 
"/usr/local/sbin:/usr/local/bin:/usr/sbin:/usr/bin:/sbin:/bin:/snap/bin"
PHP_SELF 
"/index.php"
QUERY_STRING 
""
REDIRECT_STATUS 
"200"
REDIRECT_UNIQUE_ID 
"aUIeTszlRZo6IXaMXMMK2QAAAAE"
REDIRECT_URL 
"/fachartikel/eosinophile-oesophagitis-eoe-eine-noch-haeufig-uebersehene-erkrankung-der-speiseroehre"
REMOTE_ADDR 
"192.168.20.3"
REMOTE_PORT 
"40442"
REQUEST_METHOD 
"GET"
REQUEST_SCHEME 
"http"
REQUEST_TIME 
1765940814
REQUEST_TIME_FLOAT 
1765940814.6265
REQUEST_URI 
"/fachartikel/eosinophile-oesophagitis-eoe-eine-noch-haeufig-uebersehene-erkrankung-der-speiseroehre"
SCRIPT_FILENAME 
"/var/www/vhosts/dev-plesk.creatediv.local/apofalk-academy.dev-plesk.creatediv.local/htdocs/public/index.php"
SCRIPT_NAME 
"/index.php"
SERVER_ADDR 
"192.168.20.6"
SERVER_ADMIN 
"[no address given]"
SERVER_NAME 
"apofalk-academy.dev-plesk.creatediv.local"
SERVER_PORT 
"80"
SERVER_PROTOCOL 
"HTTP/1.0"
SERVER_SIGNATURE 
"<address>Apache Server at apofalk-academy.dev-plesk.creatediv.local Port 80</address>\n"
SERVER_SOFTWARE 
"Apache"
SYMFONY_DOTENV_VARS 
"APP_ENV,APP_SECRET,DATABASE_URL,MESSENGER_TRANSPORT_DSN,MAILER_DSN,MAILER_NAME,MAILER_USER,WKHTMLTOPDF_PATH,GOOGLE_CAPTCHA_KEY,POINTS_NEEDED_FOR_CLUB,POINTS_FOR_QUIZ,POINTS_FOR_ELEARNING"
UNIQUE_ID 
"aUIeTszlRZo6IXaMXMMK2QAAAAE"
USER 
"dev-plesk"
proxy-nokeepalive 
"1"