2226-5988 2686-6749 Клиническая и экспериментальная морфология Clinical and Experimental Morphology ООО "Группа МДВ" 10.31088/CEM2023.12.3.5-18 Клинико-морфологическая диагностика эозинофильного эзофагита Clinical and morphological diagnosis of eosinophilic esophagitis Масленкина Ксения Сергеевна Масленкина Ксения Сергеевна Maslenkina Ksenia S. cem.journal@mail.ru 0000-0001-8083-9428 Михалева Людмила Михайловна Михалева Людмила Михайловна Mikhaleva Liudmila M. mikhalevalm@yandex.ru 0000-0003-2052-914X Мотылев Евгений Николаевич Мотылев Евгений Николаевич Motylev Eugeny N. cem.journal@mail.ru 0000-0002-9453-3515 Гущин Михаил Юрьевич Гущин Михаил Юрьевич Gushchin Mikhail U. cem.journal@mail.ru 0000-0002-1041-8561 Кайбышева Валерия Олеговна Кайбышева Валерия Олеговна Kaibysheva Valeria O. cem.journal@mail.ru 0000-0003-0114-3700 Атякшин Дмитрий Андреевич Атякшин Дмитрий Андреевич Atyakshin Dmitry A. cem.journal@mail.ru 0000-0002-8347-4556 Кудрявцева Яна Юрьевна Кудрявцева Яна Юрьевна Kudryavtseva Yana Y. cem.journal@mail.ru 0000-0002-7218-0798 Кудрявцев Георгий Юрьевич Кудрявцев Георгий Юрьевич Kudryavtsev Georgy Y. cem.journal@mail.ru 0000-0001-7921-9758 Научно-исследовательский институт морфологии человека имени академика А.П. Авцына ФГБНУ «Российский научный центр хирургии имени академика Б.В. Петровского» (Москва, Россия) Avtsyn Research Institute of Human Morphology of FSBSI “Petrovsky National Research Centre of Surgery” (Moscow, Russia) ФГАОУ ВО Российский национальный исследовательский медицинский университет имени Н.И. Пирогова Минздрава России (Москва, Россия) Pirogov Russian National Research Medical University (Moscow, Russia) ФГАОУ ВО Российский университет дружбы народов имени Патриса Лумумбы (Москва, Россия) Patrice Lumumba Peoples’ Friendship University of Russia (Moscow, Russia) 25 09 2023 2023 12 3 5 18 03 04 2023 20 06 2023 18 04 2023

Эозинофильный эзофагит (ЭоЭ) – иммуноопосредованное заболевание пищевода, которое проявляется дисфагией и болюсной обструкцией пищей и при патоморфологическом исследовании характеризуется преимущественно эозинофильной интраэпителиальной инфильтрацией. Цель обзора – изучить клинико-морфологические особенности ЭоЭ в аспекте дифференциальной диагностики с другими заболеваниями пищевода. Спектр таких заболеваний многогранен, включая гастроэзофагеальную рефлюксную болезнь (ГЭРБ), воспалительные заболевания кишечника, группу аутоиммунных заболеваний, а также редкие заболевания пищевода. Клиническая картина дисфагии и болюсной обструкции пищевода, а также эндоскопические признаки EREFS (Endoscopic Reference Score) характерны для ЭоЭ. При этом многочисленные исследования показали, что эозинофилия слизистой оболочки, обнаруживаемая при патоморфологическом исследовании, является неспецифическим признаком поражения пищевода и недостаточна для диагностики ЭоЭ. В связи с этим разработана морфологическая шкала оценки эозинофильного эзофагита (Eosinophilic Esophagitis Histological Scoring System, EoEHSS), которая включает оценку выраженности интраэпителиальной инфильтрации эозинофилами, базальноклеточной гиперплазии, эозинофильных абсцессов, поверхностного наслоения эозинофилов, расширения межклеточных пространств, повреждения поверхностного эпителия, дискератоза и фиброза собственной пластинки слизистой оболочки пищевода. Комплексная оценка клинических, эндоскопических и патоморфологических признаков позволяет точно диагностировать ЭоЭ и другие причины эозинофилии пищевода.

Eosinophilic esophagitis (EoE) is an immune-mediated disease that presents with dysphagia and esophageal bolus obstruction and is characterized by predominant intraepithelial eosinophilic inltration at histology. The aim of our literature review was to delineate clinical and morphological EoE features in terms of dierential diagnosis with other esophageal diseases, i.e., gastroesophageal reux disease (GERD), inammatory bowel diseases (IBDs), autoimmune diseases, and rare esophageal disorders. Clinical features of dysphagia and esophageal bolus obstruction and endoscopic criteria (according to EREFS) are typical of EoE. Nevertheless, eosinophilia of the esophageal mucosa is not a specic marker of mucosal injury and is not sucient for EoE diagnosis. Therefore, eosinophilic esophagitis histological scoring system (EoEHSS) was developed. It involves assessment of intraepithelial eosinophilic infiltration, basal zone hyperplasia, eosinophilic abscesses, eosinophil surface layering, dilated intercellular spaces, surface epithelial alteration, dyskeratotic epithelial cells, and lamina propria fibrosis. Complex clinical, endoscopic, and histological evaluation allows accurate diagnosis of EoE and other causal factors of esophageal eosinophilia.

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