Encuentro Dr. Alfredo Lucendo

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El sábado día 18 de junio de 2016 el Equipo de Alpedia (Alergia Infantil & Pediatría) de la Dra. Celia Pinto organizó una reunión con el Dr. Alfredo Lucendo (Médico Responsable del Servicio de Aparato Digestivo del Hospital General de Tomelloso en Ciudad Real y Responsable del Comité de Investigación de la Sociedad Española de Patología Digestiva SEPD), con la Asociación Española de Esofagitis Eosinofílica Aedeseo (Asociación que sin ánimo de lucro brinda apoyo a personas afectadas por esta enfermedad) y con facultativos especialistas de Alergología e Inmunología, Gastroenterología, Medicina Interna y Pediatría General de diferentes hospitales y centros de Madrid.

 

La reunión comenzó con la exposición magistral del Dr. Lucendo en la que afianzó los conceptos actuales sobre la Esofagitis Eosinofílica (EoE) y las bases de su diagnóstico y tratamiento. Muchos de los conocimientos actuales sobre esta enfermedad se deben a las investigaciones de los Equipos del Dr. Lucendo y de su compañero el Dr. Molina-Infante (Médico Adjunto del Servicio de Apato Digestivo del Hospital San Pedro de Alcántara, Cáceres y Coordinador del Grupo de trabajo de Enfermedades del Ésofago, Estómago y Duodeno de la (Asociación Española de Gastroenterología), convirtiendo a España en la pionera a nivel europeo en la investigación de EoE en la actualidad.
Para concluir nos habló sobre uno de sus proyectos de investigación sobre esta patología, y sobre páginas web de interés para médicos y pacientes, que comentaremos posteriormente.

A continuación Mª Jesús Sánchez, Secretaria actual de la Junta Directiva de Aedeseo y madre de una niña con esta patología, realizó una conmovedora presentación de los resultados de una encuesta coordinada por la Dra. Ruth García, responsable de la Comisión Médica de la Asociación, sobre el impacto de la Esofagitis Eosinofílica sobre los niños y sus familias, en la que expuso como se convive con esta patología, cómo se enfrentan a los diferentes tratamientos y sobre todo, cómo afecta a su calidad de vida.

El objetivo de la reunión fue crear un punto de encuentro entre el Dr. Lucendo, como experto investigador español de la Esofagitis Eosinofílica de ámbito nacional e internacional, con la Asociación Aedeseo, que representa a nivel nacional a los pacientes y sus familias, y con médicos de diferentes especialidades que atienden a pacientes con esta patología; con el fin de formar un grupo de apoyo y trabajo, que divulgue socialmente esta enfermedad a través de diferentes medios, dado que es poco conocida pero cada vez más prevalente, especialmente en la población infantil.

 

be31cb65-2c4f-4e9c-a2cd-3cb5a47d7700_749_499La Esofagitis Eosinofílica (EoE) es una enfermedad crónica del esófago, mediada por el sistema inmunológico y por antígenos alimentarios, siendo las principales células implicadas un tipo específico de leucocitos llamados eosinófilos, que producen una inflamación en la pared del esófago, con alteración en su motilidad, y que se manifiesta clínicamente con uno o varios de los siguientes síntomas: dificultad para tragar alimentos sólidos, atragantamiento, impactación alimentaria, síntomas similares al reflujo gastroesofágico, tos durante la ingesta o vómitos. En los niños más pequeños puede provocar trastornos del sueño, rechazo a los alimentos, con un consecuente retraso en el crecimiento.

Recientemente, se ha identificado un nuevo síntoma: el dolor torácico inducido por el ejercicio físico.
Esta enfermedad afecta a todas las edades, aunque predomina en la infancia y adolescencia. Cada vez es más prevalente, estimándose que actualmente la padecen 1 de cada 2000 personas en los países industrializados. Como consecuencia, la EoE representa hoy la segunda causa de esofagitis crónica tras el reflujo gastroesofágico y en la principal causa de disfagia y problemas de deglución entre los pacientes jóvenes.

La clave para sospechar una EoE es prestar atención a la actitud del niño cuando come: suelen dar sorbos frecuentes de agua, son comedores lentos “los últimos en levantarse de la mesa”, mastican la comida mucho tiempo, evitan comer ciertos alimentos coo el pan, el arroz o la carne, y les gusta ingerir bebidas gaseosas “coca-cola” durante las comidas. Estas actitudes no son más que mecanismos adaptativos que realiza inconscientemente el paciente para mejorar su ingesta.

Las pruebas alergológicas actuales (pruebas cutáneas y analítica con IgE específica para alimentos) no tienen utilidad en esta patología (no existe correlación entre sus resultados con respecto a los alimentos que desencadenan la EoE)

lucendopresentacionEl Dr. Lucendo destacó en su presentación, que a pesar de que la mayoría de los pacientes afectos de EoE son atópicos, esta asociación no es universal, es decir, que puede afectar a niños y adultos no alérgicos, que las pruebas alergológicas actuales (pruebas cutáneas y analítica con IgE específica para alimentos) no tienen utilidad en esta patología (no existe correlación entre sus resultados con respecto a los alimentos que desencadenan la EoE) dado que su mecanismo inmunológico no es “IgE mediado”. No obstante todos los pacientes, sean o no atópicos, presentan las mismas características clínicas y de respuesta al tratamiento.
El diagnóstico de la enfermedad se establece en base a síntomas clínicos de disfunción/dismotilidad esofágica comentados anteriormente y a los resultados de las biopsias esofágicas compatibles realizadas por endoscopia (≥ 15 Eosinófilos/HPF-campo de gran aumento).
Las investigaciones actuales se centran en el descubrimiento de los mecanismos inmunopatogénicos causantes de esta enfermedad, habiéndose identificado el papel clave de las citocinas de tipo Th2 (IL-5 y 13), en el reclutamiento y activación de los eosinófilos y actualmente se está investigando también el papel de la IgG4. No obstante su acción en el esófago no se reproduce en sangre periférica, por lo que actualmente no se dispone de ningún marcador en sangre de actividad, o lo que es lo mismo, la analítica sanguínea no es de utilidad.

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