Russian Journal of AllergyRussian Journal of AllergyРоссийский Аллергологический Журнал1810-88302686-682XPublishing House ABV Press1700110.36691/RJA17001ReviewsНаучные обзорыResearch ArticleTreatment of eosinophilic esophagitis: literature review and own clinical observationsЛечение эозинофильного эзофагита: обзор литературы и описание собственных клинических наблюденийhttps://orcid.org/0000-0003-0114-37003954-1379KaibyshevaValeria O.КайбышеваВалерия Олеговна
Russian Federation

MD, Cand. Sci. (Medicine)

канд. мед. наук

valeriakai@mail.ruhttps://orcid.org/0000-0002-6036-70616785-9959FedorovEvgeniy D.ФедоровЕвгений Дмитриевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

efedo@mail.ruhttps://orcid.org/0000-0002-1571-81258510-5985ShapovalyantsSergey G.ШаповальянцСергей Георгиевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

sgs31@mail.ruThe Russian National Research Medical University named after N.I. PirogovРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова060320251004202522123430702202526022025Copyright ©; 2025, PH “ABV-Press”Copyright ©; 2025, ООО «ИД «АБВ-пресс»2025PH “ABV-Press”ООО «ИД «АБВ-пресс»https://creativecommons.org/licenses/by-nc-nd/4.0/https://rusalljournal.ru/raj/article/view/17001

Eosinophilic esophagitis is a T2 disease characterized by eosinophilic infiltration of the esophageal mucosa, subepithelial and submucosal fibrosis, and progressive dysphagia. Early diagnosis and appropriate treatment of eosinophilic esophagitis can prevent the development of strictures and other complications. The treatment of eosinophilic esophagitis includes the use of elimination diets, pharmacological therapy, and endoscopic dilation or bougienage of the esophageal strictures. The most effective drugs for achieving clinical and histological remission in eosinophilic esophagitis are proton pump inhibitors, topical glucocorticosteroids, and biological agents represented by monoclonal antibodies. Over time, the advantages of systemic monoclonal antibody therapies (anti-interleukin 4/13) over proton pump inhibitors and topical glucocorticosteroids have become evident, particularly in terms of their impact on mucosal inflammation and on remodeling of the esophageal wall. Currently, the only approved anti-interleukin drug for eosinophilic esophagitis is dupilumab, which has demonstrated high efficacy and safety in clinical trials and is approved for use in children aged 1 year and older, as well as in adults. Endoscopic dilation or bougienage is performed in patients with eosinophilic esophagitis who have esophageal strictures and stenosis (with an esophageal diameter <13 mm) following a course of pharmacotherapy. To this day, numerous questions remain regarding maintenance therapy, its duration, and predictors of disease progression. With the emergence of new biologic therapies for eosinophilic esophagitis, their accessibility, long-term efficacy, and safety have become critically important considerations.

The article systemizes existing data on the treatment strategies for patients with eosinophilic esophagitis.

Эозинофильный эзофагит — Т2-заболевание пищевода, характеризующееся эозинофильной инфильтрацией слизистой оболочки пищевода, развитием субэпителиального и подслизистого фиброза, прогрессирующей дисфагией. Своевременная диагностика и адекватное лечение эозинофильного эзофагита позволяют предотвратить развитие стриктур и других осложнений заболевания.

Лечение эозинофильного эзофагита включает использование элиминационных диет, назначение медикаментозной терапии, проведение эндоскопической дилатации или бужирования пищевода при развитии стриктур. Наиболее эффективными препаратами, позволяющими добиться клинической и гистологической ремиссии при эозинофильном эзофагите, являются ингибиторы протонной помпы, топические глюкокортикостероиды и биологические препараты, представленные моноклональными антителами.

С течением времени становятся очевидными преимущества применения системно-действующих препаратов моноклональных антител (анти-интерлейкин 4/13) по сравнению с ингибиторами протонной помпы и топическими глюкокортикостероидами с точки зрения влияния на процессы воспаления в слизистой оболочке и ремоделирования всей толщи стенки пищевода. Единственным одобренным при эозинофильном эзофагите генно-инженерным биологическим препаратом является дупилумаб, показавший в клинических исследованиях высокую эффективность и безопасность и разрешенный к применению у детей с 1 года и взрослых. Эндоскопическая дилатация или бужирование проводится пациентам со стриктурами и стенозом пищевода (при диаметре пищевода <13 мм) после курса медикаментозной терапии.

Остается много вопросов, касающихся поддерживающей терапии, ее длительности, предикторов прогрессирования заболевания. С появлением новых биопрепаратов для лечения эозинофильного эзофагита крайне актуальными стали вопросы их доступности, эффективности и безопасности в долгосрочной перспективе.

В статье систематизированы данные литературы о тактике лечения пациентов с эозинофильным эзофагитом.

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