Çocuklarda Görülen Eozinofilik Özefajit ve Tıbbi Beslenme Tedavisi

Öz

Eozinofilik özefajit (EoÖ), özefagus disfonksiyonu ve eozinofil baskın inflamasyonla ilişkili semptomlarla karakterize bir hastalıktır. Beslenme sorunları, mide bulantısı, kusma gibi spesifik olmayan semptomlar gösterebilmektedir. Bu semptomlarla karakterize özofagus histolojisinde ≥ 15 eozinofil/büyük büyütme alanı (HPF) görülmesi ile tanısı konulmaktadır. Hem genetik hem de çevresel faktörler hastalığın gelişimine katkıda bulunmaktadır. Çocuklarda eozinofilik özofajitin artan prevalansı dikkatleri çevresel maruziyetlere çekmiştir. İlk olarak, besin alerjenleri EoÖ'yi tetiklemektedir. Bu bağlamda önerilen çeşitli diyet yöntemleri elemental diyet, ampirik eliminasyon diyetleri ve alerji testine dayalı eliminasyon diyetleri olmak üzere üç ana gruba ayrılmaktadır. Elemental diyette çocuğa protein içermeyen amino asit bazlı bir formül verilmektedir. Bu yönüyle alerjen içermemesi ve besin öğesi açısından eksiksiz oluşu çocukta herhangi bir malnütrisyona neden olmamaktadır. Ampirik eliminasyon diyetleri ise alerjen özelliği yüksek gıdaların diyetten çıkarılmasını içermektedir. Bu bağlamda süt, yumurta, buğday gibi besinler diyetten elimine edilmektedir. Bu tedavi yönteminde hem uygulamayı kolaylaştırmak hem de yapılan endoskopi sayısını azaltmak için dört gıda eliminasyon diyetleri ya da tekli ve ikili eliminasyon diyetleri de araştırılmaktadır. Alerjen testine dayalı eliminasyon diyetlerinde farklı yöntemlerle çocuğun alerjik reaksiyon gösterdiği besinin tespit edilmesi amaçlanmıştır. Kuvvetle şüphelenilen ve test sonucu pozitif çıkan besin veya besinler diyetten elimine edilmektedir. Her üç diyet tedavisi de etkilidir ancak elemental diyet, ampirik eliminasyon diyetleri ve alerji testine yönelik eliminasyon diyetlerle karşılaştırıldığında histolojik remisyonda daha üstündür. Tüm tıbbi beslenme tedavileri incelendiğinde avantajları, dezavantajları değerlendirilerek çocuğa en uygun tıbbi beslenme tedavisi uygulanmalıdır.

Anahtar Kelimeler

• Elemental diyet
• eliminasyon diyetleri
• eozinofilik özofajit

Destekleyen Kurum

Herhangi bir kurum ya da kuruluştan finansal destek alınmamıştır.

Etik Beyan

Bu bir inceleme makalesidir.

Eosinophilic Esophagitis in Children and Medical Nutrition Treatment

Öz

Eosinophilic esophagitis (EoE) is a disease characterized by symptoms related to esophageal dysfunction and eosinophil-dominant inflammation. It may present with nonspecific symptoms such as feeding problems, nausea, and vomiting. It is diagnosed by the observation of ≥ 15 eosinophils/high-power field (HPF) in esophageal histology characterized by these symptoms. Both genetic and environmental factors contribute to the development of the disease. The increasing prevalence of eosinophilic esophagitis in children has drawn attention to environmental exposures. First, food allergens trigger EoE. In this context, various recommended dietary methods are divided into three main groups: elemental diet, empirical elimination diets, and elimination diets based on allergy testing. In the elemental diet, the child is given a protein-free amino acid-based formula. In this respect, it does not contain allergens and is complete in terms of nutrients, and does not cause any malnutrition for the child. Empirical elimination diets involve the removal of foods with high allergenic properties from the diet. In this context, foods such as milk, eggs, and wheat are eliminated from the diet. In this treatment method, four-food elimination diets or single and double elimination diets are also being investigated in order to both facilitate the application and reduce the number of endoscopies performed. In elimination diets based on allergen testing, the aim is to determine the food to which the child has an allergic reaction using different methods. The food or foods that are strongly suspected and have a positive test result are eliminated from the diet. All three dietary treatments are effective, but the elemental diet is superior in histological remission when compared to empirical elimination diets and allergy test-based elimination diets. When all medical nutrition treatments are examined, the most appropriate medical nutrition treatment should be applied to the child by evaluating their advantages and disadvantages.

Anahtar Kelimeler

• Elemental Diet
• elimination diets
• eosinophilic esophagitis

Destekleyen Kurum

This research did not receive support from any funding agency/industry.

Etik Beyan

This is a review article.

Kaynakça

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