需要了解的三点
- 嗜酸性粒细胞性食管炎（EoE）是吞咽困难的原因之一。
- 药物有助于控制炎症。扩张治疗可以帮助撑开由EoE瘢痕造成的狭窄。
- 感觉好转不一定意味着炎症已消退。活检有助于判断治疗效果。
观看：认识EoE
视频为英语旁白及英语字幕。以下中文指南涵盖主要内容。
选择章节（英语）
阅读英语文字稿
Difficulty swallowing
People with eosinophilic oesophagitis, or EoE, often have difficulty swallowing, called dysphagia. Food getting stuck often means they need to chew more carefully, take smaller bites or change the texture of their food to make swallowing easier.
Inflammation in the lining
EoE is an immune-related condition affecting the oesophagus, the tube that carries food to the stomach. Inflammatory cells called eosinophils build up in its lining. The lining can become swollen, leaving less room for food to pass.
Rings and narrowing
Over time, ongoing inflammation can also lead to scarring. The oesophagus may become less flexible, and rings or a tighter narrowing can develop. These changes do not happen to everyone with EoE.
Why food can stick
A mouthful of solid food may move more slowly through a narrowed area, or become lodged there. This helps explain why swallowing can be difficult even when someone has learned to eat very carefully.
From biopsy to microscope
Sometimes the oesophagus looks relatively normal during gastroscopy. Small tissue samples, called biopsies, are therefore needed. The samples are examined under a microscope to look for eosinophils and other tissue changes that help establish the diagnosis.
Treat the inflammation
Treatment aims to settle the inflammation with medicines, dietary therapy, or a combination of both. As inflammation settles, swelling can reduce and the opening can widen. The choice of treatment depends on the findings, previous treatment and what is practical to maintain.
Widen a significant narrowing
If inflammation has caused scarring and narrowing, stretching, called dilatation, may be performed during the endoscopy to make swallowing easier. Treatment to control the inflammation is still needed to help prevent further scarring.
Check healing and know when to seek help
Follow-up may include another gastroscopy and biopsies to check how well treatment is working. If food becomes stuck and you cannot swallow saliva, seek urgent medical care. Call 111 for severe breathing difficulty.
吞咽方式的变化
吞下食物后，可能感觉食物通过缓慢或卡住，这称为吞咽困难。有些人会延长咀嚼时间、减小每一口的分量、避免肉类或面包，或改吃较软的食物。即使您觉得自己还能应付，也请告诉我这些变化。
我会询问问题出现在固体食物、液体还是两者，是否逐渐加重，以及是否曾需要通过内镜取出卡住的食物。这有助于区分食管狭窄与食管运动问题。EoE只是可能的原因之一，因此新出现或加重的吞咽困难需要评估。
如何诊断EoE
胃镜让我检查食管是否有环状改变、狭窄或其他异常，并从不同部位取少量组织。食管黏膜有时看起来相对正常，因此即使镜下外观没有明显异常，活检仍很重要。
病理医生用显微镜检查组织中的嗜酸性粒细胞及其他变化。我会结合症状、内镜所见和其他可能引起炎症的原因来判断。
检查前的药物与饮食
抑酸药、吞服类固醇和食物排除饮食可能影响活检结果。请告知您正在服用的药物及避免的食物。遵循本次检查的说明，不要自行停用处方治疗或改变饮食。
这是否等同于即时食物过敏？
EoE常与哮喘、湿疹或花粉症同时存在，但其食物诱因与即时过敏反应不同。皮肤点刺或血液过敏检测不能可靠地找出引起EoE的食物。如果进食后立即出现过敏症状，仍需另行评估。
EoE会增加患癌风险吗？
EoE目前不被认为是癌前病变，现有证据也没有证明EoE会导致食管癌。EoE可引起吞咽困难或食物卡住，这些症状也可能见于包括癌症在内的其他疾病，因此新出现、持续或加重的症状仍需适当评估，不能仅仅假定是EoE。
治疗的三个方面：药物、饮食和扩张
药物与饮食治疗用于控制炎症；必要时，扩张治疗可撑开瘢痕造成的狭窄。这些方法可以结合使用。我会考虑活检结果、狭窄程度、既往治疗，以及您在日常生活中能够长期坚持的方法。
观看：治疗EoE
视频为英语旁白及英语字幕。以下中文指南涵盖主要内容。
选择章节（英语）
阅读英语文字稿
The three Ds
EoE treatment can be thought of as the three Ds: drugs, diet and dilatation. Medicines and dietary treatment address the inflammation. Dilatation helps when narrowing is making swallowing difficult. Some people need more than one approach.
Often starting with omeprazole
Treatment often starts with omeprazole, a proton pump inhibitor commonly used for reflux. It can also help people with EoE who do not have reflux. In a large review of proton pump inhibitors, about forty-five percent of patients reached remission, meaning the inflammatory cell count on biopsies fell below the diagnostic threshold.
Swallowed steroid treatment
Another option is a swallowed steroid, which acts directly on the lining. Fluticasone from a metered-dose inhaler, such as Flixotide, can be prescribed to swallow rather than breathe in. This is an off-label use. Budesonide tablets, called Jorveza, dissolve in the mouth and are swallowed with saliva. Jorveza is not currently publicly funded in New Zealand for EoE.
Targeted treatment
Dupilumab is a targeted treatment that blocks specific signals involved in inflammation. It can help some people whose EoE remains active despite other treatment. It is not currently available as a routine EoE treatment in New Zealand.
Diet: often begin with milk
Dietary treatment aims to identify foods that trigger the inflammation. Often, the starting point is removing animal milk and dairy products. In one adult trial, thirty-four percent achieved remission on biopsies after six weeks of milk elimination alone. This means avoiding milk protein, not simply choosing lactose-free milk.
A broader diet when needed
A six-food elimination diet removes milk, wheat, egg, soy, nuts and seafood. It is more restrictive, so it is not always the first step. A dietitian can help with suitable replacements and nutrition. Foods are reintroduced in a planned way, with biopsies used to check which changes have helped.
Dilatation when narrowing persists
If a scarred narrowing is affecting swallowing, dilatation may be needed as well. A balloon gently stretches the narrowed area. Some people need more than one session, and medicines or dietary treatment continue to address the inflammation.
The goals of treatment
The goals are to control inflammation, relieve swallowing symptoms, reduce further scarring and long-term damage, and restore quality of life. Because symptoms can improve before the inflammation has settled, follow-up biopsies help guide ongoing treatment.
控制炎症的药物
奥美拉唑及其他质子泵抑制剂
治疗通常从奥美拉唑开始，这是一种常用的胃食管反流药物。即使没有反流，它也可能改善EoE。一项大型综述发现，使用质子泵抑制剂后约45%的患者在活检中达到缓解。这是此类药物的总体估计，并非仅针对奥美拉唑。请按处方持续用药；调整治疗前，我会评估疗效。
吞服类固醇：氟替卡松与Jorveza
这些药物直接作用于食管黏膜。医生可能开具定量吸入器中的氟替卡松，例如Flixotide，用于吞服而非吸入。这属于超说明书用法，需要明确的使用指导。Jorveza含布地奈德，药片在口中溶解后随唾液吞下。请遵循相应制剂的具体说明。口腔或食管念珠菌感染是可能的副作用；如出现口腔疼痛、白色斑块或新出现的吞咽疼痛，请告知。
靶向治疗：度普利尤单抗
度普利尤单抗（dupilumab）阻断特定炎症信号，在海外用于部分EoE患者。目前新西兰尚不能将其作为常规EoE治疗。
避免不必要限制的饮食治疗
目标是找出引起炎症的食物，同时保持饮食营养充足且易于实行。我们通常先尝试排除动物乳及乳制品，而不是一次去掉多类食物。
先从排除乳类开始
一项成人试验中，仅排除动物乳六周后，34%的参与者在活检中达到缓解。需要避免的是乳蛋白，而不只是乳糖。无乳糖牛奶仍含乳蛋白。营养师可帮助您阅读食品标签、选择替代品，并保证钙和蛋白质摄入。
何时考虑更广泛的排除饮食
六类食物排除饮食包括乳类、小麦、蛋、大豆、坚果和海鲜。限制较多，因此不一定作为第一步。如果炎症持续，我会与您讨论扩大饮食排除范围或调整药物。之后按计划逐步重新引入食物，通过活检而非仅凭症状判断效果。
进食方面的额外支持
如果体重下降、已避免多类食物，或难以满足营养需求，营养师评估尤其有帮助。若另有开始吞咽困难、进食时咳嗽，或需要评估的持续吞咽习惯，言语语言治疗师也可能提供帮助。
狭窄何时需要扩张
如果炎症已造成瘢痕和狭窄，可在内镜检查时进行扩张，以改善吞咽。我通常使用球囊；对于某些非常紧或较长的食管狭窄，可选择导丝引导的Savary扩张器。
扩张可能需要循序渐进，并进行不止一次。药物或饮食治疗仍很重要，因为扩张本身不治疗炎症。术前会讨论可能的获益与风险。
检查愈合并维持控制
随访会综合评估吞咽情况、内镜外观和活检结果。有时只是因为改变了进食方式，症状就减轻，但炎症仍存在。复查胃镜并取活检，有助于决定继续、调整或更换治疗。
EoE通常需要持续治疗。炎症受控后，我们会根据检查结果商定维持治疗和随访。目标是顺畅吞咽、减少食物卡住、减少进一步形成瘢痕，并恢复正常生活质量。
如果食物卡住
如果食物持续卡住，请尽快寻求紧急医疗评估。若无法吞咽唾液，应立即前往急诊。不要再吃东西或喝水，试图强行将食物冲下去。
如有严重呼吸困难，请拨打111。即使卡住的情况已缓解，仍需要随访以评估原因和治疗。
适合您的治疗及随访建议会记录在诊疗信函、内镜或活检报告中。