需要了解的三點
- 嗜酸性球性食道炎（EoE）是吞嚥困難的原因之一。
- 藥物有助於控制發炎。擴張治療可以幫助撐開由EoE疤痕造成的狹窄。
- 感覺好轉不一定代表發炎已消退。組織切片有助於判斷治療效果。
觀看：認識EoE
影片為英語旁白及英語字幕。以下中文指南涵蓋主要內容。
選擇章節（英語）
閱讀英語文字稿
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.
吞嚥方式的變化
吞下食物後，可能感覺食物通過緩慢或卡住，這稱為吞嚥困難。有些人會延長咀嚼時間、減少每一口的份量、避免肉類或麵包，或改吃較軟的食物。即使您覺得自己還能應付，也請告訴我這些變化。
我會詢問問題出現在固體食物、液體還是兩者，是否逐漸加重，以及是否曾需要透過內視鏡取出卡住的食物。這有助於區分食道狹窄與食道運動問題。EoE只是可能的原因之一，因此新出現或加重的吞嚥困難需要評估。
如何診斷EoE
胃鏡讓我檢查食道是否有環狀變化、狹窄或其他異常，並從不同部位取少量組織。食道黏膜有時看起來相對正常，因此即使鏡下外觀沒有明顯異常，組織切片仍很重要。
病理醫師用顯微鏡檢查組織中的嗜酸性球及其他變化。我會結合症狀、內視鏡所見和其他可能引起發炎的原因來判斷。
檢查前的藥物與飲食
抑酸藥、吞服類固醇和食物排除飲食可能影響切片結果。請告知您正在服用的藥物及避免的食物。遵循本次檢查的說明，不要自行停用處方治療或改變飲食。
這是否等同於立即型食物過敏？
EoE常與氣喘、濕疹或花粉症同時存在，但其食物誘因與立即型過敏反應不同。皮膚點刺或血液過敏檢測不能可靠地找出引起EoE的食物。如果進食後立即出現過敏症狀，仍需另行評估。
EoE會增加患癌風險嗎？
EoE目前不被認為是癌前病變，現有證據也沒有證明EoE會導致食道癌。EoE可引起吞嚥困難或食物卡住，這些症狀也可能見於包括癌症在內的其他疾病，因此新出現、持續或加重的症狀仍需適當評估，不能僅僅假定是EoE。
治療的三個方面：藥物、飲食和擴張
藥物與飲食治療用於控制發炎；必要時，擴張治療可撐開疤痕造成的狹窄。這些方法可以合併使用。我會考慮切片結果、狹窄程度、過去的治療，以及您在日常生活中能夠長期維持的方法。
觀看：治療EoE
影片為英語旁白及英語字幕。以下中文指南涵蓋主要內容。
選擇章節（英語）
閱讀英語文字稿
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.
控制發炎的藥物
Omeprazole及其他質子幫浦抑制劑
治療通常從omeprazole開始，這是一種常用的胃食道逆流藥物。即使沒有逆流，它也可能改善EoE。一項大型綜述發現，使用質子幫浦抑制劑後約45%的病人在切片中達到緩解。這是此類藥物的整體估計，並非只針對omeprazole。請依處方持續用藥；調整治療前，我會評估療效。
吞服類固醇：fluticasone與Jorveza
這些藥物直接作用於食道黏膜。醫師可能開立定量吸入器中的fluticasone，例如Flixotide，用於吞服而非吸入。這屬於仿單核准範圍外的用法，需要明確的使用指導。Jorveza含budesonide，藥片在口中溶解後隨唾液吞下。請遵循相應製劑的具體說明。口腔或食道念珠菌感染是可能的副作用；如出現口腔疼痛、白色斑塊或新出現的吞嚥疼痛，請告知。
標靶治療：dupilumab
Dupilumab阻斷特定發炎訊號，在海外用於部分EoE病人。目前紐西蘭尚不能將其作為常規EoE治療。
避免不必要限制的飲食治療
目標是找出引起發炎的食物，同時保持飲食營養充足且容易實行。我們通常先嘗試排除動物乳及乳製品，而不是一次去掉多類食物。
先從排除乳類開始
一項成人試驗中，只排除動物乳六週後，34%的參與者在切片中達到緩解。需要避免的是乳蛋白，而不只是乳糖。無乳糖牛奶仍含乳蛋白。營養師可協助您閱讀食品標示、選擇替代品，並確保鈣和蛋白質攝取。
何時考慮更廣泛的排除飲食
六類食物排除飲食包括乳類、小麥、蛋、大豆、堅果和海鮮。限制較多，因此不一定作為第一步。如果發炎持續，我會與您討論擴大飲食排除範圍或調整藥物。之後依計畫逐步重新引入食物，透過切片而非只憑症狀判斷效果。
進食方面的額外支持
如果體重下降、已避免多類食物，或難以滿足營養需求，營養師評估尤其有幫助。若另有開始吞嚥困難、進食時咳嗽，或需要評估的持續吞嚥習慣，語言治療師也可能提供協助。
狹窄何時需要擴張
如果發炎已造成疤痕和狹窄，可在內視鏡檢查時進行擴張，以改善吞嚥。我通常使用球囊；對於某些非常緊或較長的食道狹窄，可選擇導絲引導的Savary擴張器。
擴張可能需要循序漸進，並進行不只一次。藥物或飲食治療仍很重要，因為擴張本身不治療發炎。術前會討論可能的效益與風險。
檢查癒合並維持控制
追蹤會綜合評估吞嚥情況、內視鏡外觀和切片結果。有時只是因為改變了進食方式，症狀就減輕，但發炎仍存在。再次胃鏡檢查並取切片，有助於決定繼續、調整或更換治療。
EoE通常需要持續治療。發炎受控後，我們會依檢查結果商定維持治療和追蹤。目標是順暢吞嚥、減少食物卡住、減少進一步形成疤痕，並恢復正常生活品質。
如果食物卡住
如果食物持續卡住，請儘快尋求緊急醫療評估。若無法吞嚥唾液，應立即前往急診。不要再吃東西或喝水，試圖強行將食物沖下去。
如有嚴重呼吸困難，請撥打111。即使卡住的情況已緩解，仍需要追蹤以評估原因和治療。
適合您的治療及追蹤建議會記錄在診療信函、內視鏡或組織切片報告中。