Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 6 de 6
Filter
1.
Clin Gastroenterol Hepatol ; 18(13): 2903-2911.e4, 2020 12.
Article in English | MEDLINE | ID: mdl-31988045

ABSTRACT

BACKGROUND & AIMS: Topical steroids, proton pump inhibitors (PPIs), and dietary interventions are recommended first- and second-line therapies for eosinophilic esophagitis (EoE). We investigated differences in their effectiveness in a real-world, clinical practice cohort of patients with EoE. METHODS: We collected data on the efficacy of different therapies for EoE (ability to induce clinical and histologic remission) from the multicenter EoE CONNECT database-a database of patients with a confirmed diagnosis of EoE in Europe that began in 2016. We obtained data from 589 patients, treated at 11 centers, on sex, age, time of diagnosis, starting date of any therapy, response to therapy, treatment end dates, alternative treatments, and findings from endoscopy. The baseline endoscopy was used for diagnosis of EoE; second endoscopy was performed to evaluate response to first-line therapies. After changes in treatment, generally because lack of efficacy, a last endoscopy was performed. The time elapsed between endoscopies depended on the criteria of attending physicians. Clinical remission was defined by a decrease of more than 50% in Dysphagia Symptom Score; improvement in symptoms by less than 50% from baseline was considered as clinical response. Histologic remission was defined as a peak eosinophil count below 5 eosinophils/hpf. A peak eosinophil count between 5 and 14 eosinophils/hpf was considered histologic response. We identified factors associated with therapy selection and effectiveness using χ2 and multinomial logistic regression analyses RESULTS: PPIs were the first-line treatment for 76.4% of patients, followed by topical steroids (for 10.5%) and elimination diets (for 7.8%). Topical steroids were most effective in inducing clinical and histologic remission or response (in 67.7% of patients), followed by empiric elimination diets (in 52.0%), and PPIs (in 50.2%). Among the 344 patients who switched to a second-line therapy, dietary interventions were selected for 47.1% of patients, followed by PPIs (for 29.1%) and topical steroids (for 18.6%). Clinical and histologic remission or response was achieved by 80.7% of patients treated with topical steroids, 69.2% of patients given PPIs, and 41.7% of patients on empiric elimination diets. Multivariate analyses found the stricturing phenotype of EoE to be associated with selection of topical steroids over PPIs as the first-line therapy; lack of fibrotic features at initial endoscopy was associated with selection of elimination diets over topical steroids as a second-line therapy. The recruiting center was significantly associated with therapy choice; second-line treatment with topical steroids or PPIs were the only variables associated with clinical and histologic remission. CONCLUSIONS: In an analysis of data from a large cohort of patients with EoE in Europe, we found topical steroids to be the most effective at inducing clinical and histologic remission, but PPIs to be the most frequently prescribed. Treatment approaches vary with institution and presence of fibrosis or strictures.


Subject(s)
Deglutition Disorders , Eosinophilic Esophagitis , Eosinophilic Esophagitis/drug therapy , Eosinophils , Humans , Proton Pump Inhibitors/therapeutic use , Steroids , Treatment Outcome
2.
United European Gastroenterol J ; 5(6): 819-826, 2017 Oct.
Article in English | MEDLINE | ID: mdl-29026596

ABSTRACT

BACKGROUND: Diagnosis of celiac disease is difficult when the combined results of serology and histology are inconclusive. Studies using flow cytometry of intraepithelial lymphocytes (IELs) have found that celiac patients have increased numbers of γδ IELs, along with a decrease in CD3-CD103 + IELs. OBJECTIVE: The objective of this article is to assess the role of flow cytometric analysis of IELs in the diagnosis of celiac disease in difficult cases. METHODS: A total of 312 patients with suspicion of celiac disease were included in the study. Duodenal biopsy samples were used for histological assessment and for flow cytometric analysis of IELs. RESULTS: In 46 out of 312 cases (14.7%) the combination of serology and histology did not allow the confirmation or exclusion of celiac disease. HLA typing had been performed in 42 of these difficult cases. Taking into account HLA typing and the response to a gluten-free diet, celiac disease was excluded in 30 of these cases and confirmed in the remaining 12. Flow cytometric analysis of IELs allowed a correct diagnosis in 39 out of 42 difficult cases (92.8%) and had a sensitivity of 91.7% (95% CI: 61.5% to 99.8%) and a specificity of 93.3% (95% CI: 77.9% to 99.2%) for the diagnosis of celiac disease in this setting. CONCLUSION: Flow cytometric analysis of IELs is useful for the diagnosis of celiac disease in difficult cases.

5.
Gastroenterol. hepatol. (Ed. impr.) ; 34(8): 535-538, Oct. 2011.
Article in Spanish | IBECS | ID: ibc-94523

ABSTRACT

La linitis plástica rectal es una infiltración tumoral intraparietal, subepitelial y circunferencial de la pared del recto que condiciona engrosamiento parietal y estenosis de la luz. Con frecuencia existe demora entre la aparición de los síntomas y el diagnóstico debido a que la linitis rectal simula un gran número de enfermedades y los hallazgos endoscópicos y las biopsias convencionales no son concluyentes, pues la mucosa en superficie suele no estar afectada. Presentamos los hallazgos endoscópicos y ecoendoscópicos de 2 pacientes con linitis rectal secundaria (AU)


Linitis plastica of the rectum consists of intraparietal, subepithelial and circumferential tumoral infiltration of the wall of the rectum leading to a constricted rectum with mural thickening. There is often a delay between symptom onset and diagnosis because this entity mimics a large number of diseases and the findings of endoscopy and conventional biopsies are non-conclusive since the surface mucosa is not usually affected. We present the endoscopic and echoendoscopic findings of two patients with secondary linitis plastica of the rectum (AU)


Subject(s)
Humans , Linitis Plastica/diagnosis , Rectal Neoplasms/pathology , Neoplasm Metastasis/pathology , Endosonography/methods , Endoscopy, Gastrointestinal , Diagnosis, Differential
6.
Gastroenterol Hepatol ; 34(8): 535-8, 2011 Oct.
Article in Spanish | MEDLINE | ID: mdl-21652114

ABSTRACT

Linitis plastica of the rectum consists of intraparietal, subepithelial and circumferential tumoral infiltration of the wall of the rectum leading to a constricted rectum with mural thickening. There is often a delay between symptom onset and diagnosis because this entity mimics a large number of diseases and the findings of endoscopy and conventional biopsies are non-conclusive since the surface mucosa is not usually affected. We present the endoscopic and echoendoscopic findings of two patients with secondary linitis plastica of the rectum.


Subject(s)
Carcinoma, Signet Ring Cell/secondary , Linitis Plastica/secondary , Rectal Neoplasms/secondary , Stomach Neoplasms/pathology , Aged , Biopsy, Fine-Needle , Carcinoma, Signet Ring Cell/diagnosis , Constipation/etiology , Constriction, Pathologic , Delayed Diagnosis , Fatal Outcome , Female , Humans , Intestinal Obstruction/etiology , Linitis Plastica/diagnostic imaging , Linitis Plastica/etiology , Male , Peritoneal Neoplasms/secondary , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/etiology , Rectum/pathology , Ultrasonography , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery
SELECTION OF CITATIONS
SEARCH DETAIL
...