Civatte Bodies in Pediatric Esophageal Biopsies: Does Lichen Esophagitis Pattern Occur in Children?

PURPOSE AND CONTEXT: Civatte bodies (CB) are associated with cutaneous and mucosal lichen planus in adults. They are a distinct feature of Lichen Esophagitis Pattern, which is not well described in children. We characterized clinicopathologic associations of archival esophageal CB at our Children's Hospital to determine whether lichen planus or Lichen Esophagitis Pattern occurs in children. METHOD: Pathology records were queried for pediatric esophageal biopsy diagnoses containing "CB," "apoptosis, "necrosis," or "dyskeratosis." Cases with concurrent eosinophilic/acute esophagitis were excluded. H&E slides and clinical reports were reviewed. KEY RESULTS: Biopsies with CB or similar were identified from 19 patients and had been termed "dyskeratotic cells" in 8 reports. Patients had variable age and presenting symptoms, male predominance (74%), and frequent clinical history of polypharmacy (47%), Crohn disease (42%), and/or celiac disease (21%). Civatte bodies were prominent in the distal esophagus (95%), as few isolated cells (63%), and with variable chronic inflammation (absent, pauci-inflammatory, and lichen planus-like in approximately one-third of cases each). CONCLUSIONS: We show that esophageal CB from pediatric patients are under-recognized and may have different features and implications compared to Lichen Esophagitis Pattern in adults. Recognition and documentation of pediatric esophageal CB is needed to understand their clinical significance.

Sleep duration associated with cardiovascular conditions among adult Nevadans.

BACKGROUND: Associations between sleep duration and cardiovascular conditions have been inconsistent. Both short and long sleep duration are associated with increased risk for diabetes, hypertension, obesity, high cholesterol, depression, and overall metabolic dysfunction; all of which are cardiovascular disease risk factors. This study aimed to determine if deficient or excessive sleep duration is associated with cardiovascular conditions. METHODS: Data were obtained from the 2013 Behavioral Risk Factor Surveillance System for the state of Nevada. A total of 5101 participants completed the survey and answered questions as to whether they had ever had a cardiovascular condition ie, myocardial infarction, coronary heart disease or angina, and stroke. Multiple logistic regression was implemented during analyses and yielded four models including demographics, co-morbidity, behavior, and final significant variables. RESULTS: Six significant predictor variables were identified in the final model. Sleep duration was statistically significant (p < 0.0001). Individuals having deficient sleep, eg, 1-4 h a night, were 2.4 times more likely to have a cardiovascular condition versus those sleeping 7-9 h per night (OR = 2.412, CI = 1.139, 5.107). As for individuals who sleep excessively, eg, 10-18 h a night, they were nearly 7.2 times more likely to have a cardiovascular condition, compared to individuals who receive a normal night's sleep (OR = 7.170, CI = 3.284, 15.654). CONCLUSIONS: Both deficient and excessive sleep duration were significantly associated with a cardiovascular condition, even after adjustment for covariates. The findings from this study can be used as additional evidence to encourage further research on improving sleep by developing future treatment therapies, and recommendations, that may help lower the risk of cardiovascular disease conditions.

Relation between clinical symptoms and experimental visceral hypersensitivity in pediatric patients with functional abdominal pain.

OBJECTIVE: The association between clinical symptoms and laboratory visceral sensitivity remains poorly defined and controversial. It has even been suggested that laboratory observations of visceral sensitivity are irrelevant to the clinical presentation of chronic visceral pain. To better understand this association, gastrointestinal and psychological features of pediatric patients' clinical presentation were examined in relation to a laboratory-based measure of visceral sensitivity. PATIENTS AND METHODS: At the time of their medical evaluation, 101 patients with medically unexplained abdominal pain (ages 8-15 years) completed validated questionnaires assessing recent depressive symptoms, functional disability, pain efficacy beliefs, gastrointestinal (GI), and non-GI symptoms. These clinical features were examined in relation to visceral sensitivity assessed 2 months later in the laboratory. The measure of visceral sensitivity was based on increases in GI complaints in response to the water load symptom provocation task. RESULTS: More severe GI symptoms and functional disability in the weeks before patients' clinical evaluation were associated with significantly greater increases in GI symptoms in the laboratory in response to the water load symptom provocation task (all P < 0.04). Patients believing that they had the ability to alleviate their pain (high problem-focused pain efficacy) had significantly lower laboratory visceral sensitivity (P < 0.01). Clinical depressive symptoms and non-GI symptoms were not associated with laboratory visceral sensitivity. CONCLUSIONS: Clinical presentations of more severe GI symptoms and disability as well as low perceived pain efficacy are significant predictors of laboratory visceral sensitivity in children with functional abdominal pain. Depression does not account for the association between clinical presentation of GI symptoms and a laboratory measure of visceral sensitivity.