[Eosinophilic esophagitis. Review of current clinical and physiopathological concepts]. / Esofagitis eosinofílica. Revisión de los conceptos fisiopatológicos y clínicos actuales.

Eosinophilc esophagitis (EE) is an emerging disease which is characterized by a dense infiltration of the esophagus by eosinophilic leukocytes. The main symptoms of this disease are dysphagia and frequent food impaction in esophagus, and they are due to a hypersentivity response to different foods or aeroallergens. Eosinophil accumulation in the esophageal epithelium is determined by local production of eosinophilotropic cytokines and chemokines, which have been well defined as a TH2-type hypersensitivity reaction in animal models of the disease. Esophageal epithelium, after T CD4+ lymphocytes stimulation, contains all the necessary cell types for the development of local immunoallergic responses. However, there is increasing data on the significant role that humoral immunity could play in the pathophysiology of EE, by means of the action of IgE over mast cells function. The high density of T CD8+ lymphocytes in inflammatory infiltrate suggests that a TH1-type reaction could also participate in the mechanism of the disease. Proteins contained in cytoplasmic granules of activated eosinophils and mast cells could act over neural and muscular components of the esophageal wall, triggering motor disturbances which can be measured by means of manometric recordings and justify the esophageal symptoms. This paper aims to review the newest clinical aspects of EE and the results of studies directed at investigating the pathophysiology of the disease. Furthermore, we carry out a critical review of available therapeutic options.

Esofagitis eosinofílica. Revisión de los conceptos fisiopatológicos y clínicos actuales / Eosinophilic esophagitis. Review of current clinical and physiopathological concepts

La esofagitis eosinofílica (EE) es una enfermedad emergente, caracterizada por una densa infiltración del esófago por leucocitos eosinófilos. Sus principales síntomas son la disfagia y las frecuentes impactaciones de alimento en el esófago, en respuesta a una reacción de hipersensibilidad frente a distintos alimentos o aeroalérgenos. La acumulación de eosinófilos en el epitelio esofágico, en respuesta a la producción local de citocinas y quimiocinas eosinofilotropas, se ha documentado en modelos animales, y se ha propuesto que responde a una reacción de hipersensibilidad de tipo TH2. El epitelio esofágico contiene todos los tipos celulares necesarios para desarrollar respuestas inmunoalérgicas locales, tras la estimulación de linfocitos T CD4+. Sin embargo, cada vez hay más pruebas del papel relevante que la inmunidad humoral desempeña en esta enfermedad, a través de la acción de la inmunoglobulina E, principalmente sobre los mastocitos. El predominio de linfocitos T CD8+ en el infiltrado inflamatorio también sugiere una posible reacción TH1 en el mecanismo de la enfermedad. Las proteínas contenidas en los gránulos citoplasmáticos de los eosinófilos y de los mastocitos activados podrían actuar sobre los componentes neuromusculares de la pared del esófago, desencadenando trastornos motores objetivables mediante manometría que justifican los síntomas esofágicos. En este trabajo se revisan los nuevos conceptos clínicos de la EE y los resultados de los estudios dirigidos a dilucidar la fisopatología del trastorno. Igualmente, se realiza una revisión crítica de las alternativas terapéuticas disponibles

Eosinophilc esophagitis (EE) is an emerging disease which is characterized by a dense infiltration of the esophagus by eosinophilic leukocytes. The main symptoms of this disease are dysphagia and frequent food impaction in esophagus, and they are due to a hypersentivity response to different foods or aeroallergens. Eosinophil accumulation in the esophageal epithelium is determined by local production of eosinophilotropic cytokines and chemokines, which have been well defined as a TH2-type hypersensitivity reaction in animal models of the disease. Esophageal epithelium, after T CD4+ lymphocytes stimulation, contains all the necessary cell types for the development of local immunoallergic responses. However, there is increasing data on the significant role that humoral immunity could play in the pathophysiology of EE, by means of the action of IgE over mast cells function. The high density of T CD8+ lymphocytes in inflammatory infiltrate suggests that a TH1-type reaction could also participate in the mechanism of the disease. Proteins contained in cytoplasmic granules of activated eosinophils and mast cells could act over neural and muscular components of the esophageal wall, triggering motor disturbances which can be measured by means of manometric recordings and justify the esophageal symptoms. This paper aims to review the newest clinical aspects of EE and the results of studies directed at investigating the pathophysiology of the disease. Furthermore, we carry out a critical review of available therapeutic options

Cuidados de enfermería en el paciente con cáncer de cabeza y cuello tratado con radioterapia / Nursing care of the patient with head and neck cancer treated with radiotherapy

La administración de radioterapia es un pilar fundamental en el tratamiento de la mitad de los pacientes oncológicos. El campo de administración de la radiación incluye, además del tumor, los ganglios linfáticos que drenan la zona y los tejidos sanos más próximos al tumor. Por este motivo, los efectos de la radioterapia aparecerán también sobre los tejidos sanos, resultando más sensibles los de rápida renovación, como la mucosa oral, faríngea o laríngea, los folículos pilosos y las células de la médula ósea. Este artículo revisa los efectos de la radioterapia sobre los órganos y tejidos sanos en el tratamiento de los tumores de cabeza y cuello, propone medidas de prevención o reducción de la toxicidad sobre estos, y analiza los cuidados de enfermería y las medidas de tratamiento frente a los efectos adversos locales de la radioterapia en el tratamiento de los cánceres de cabeza y cuello

Radiotherapy is one of the mainstays of the treatment of half of all oncological patients. The field of administration of radiation includes the tumoral volume, the lymph nodes that drain the area and the healthy tissues adjacent to the tumor. For this reason, the effects of radiotherapy also appear in healthy tissues and are more marked in those with a high cell turnover rate, such as the oral, pharyngeal and laryngeal mucosa and bone marrow. The present article aims to review the possible effects of radiotherapy on healthy tissues in the treatment of head and neck cancer and proposes measures to prevent or reduce toxicity. Aspects related to nursing care and treatment measures for the local adverse effects of radiotherapy are also discussed