ABSTRACT
Eosinophilic esophagitis (EoE) is a chronic and progressive immune-mediated condition defined by symptoms of esophageal dysfunction and dense eosinophilic infiltration of the esophageal mucosa. Therapies consist of anti-eosinophilic medications and specialized diets aimed to decrease the progression of EoE and alleviate its symptoms, namely, dysphagia and food impaction. Assessing response to therapy remains challenging, as treatment end points are not well defined and currently consist of clinical, histologic, and endoscopic features. Newer validated measures may help standardize treatment end points. Emerging data support the use of maintenance therapy, which may reduce disease progression. Optimal dosages, delivery techniques, and duration of treatment need to be determined. When features of fibrostenosis develop, esophageal dilation is a safe and effective adjunctive strategy for improving symptoms. In EoE cases refractory to conventional treatments, newer therapies targeting inflammatory mediators and cytokines are on the horizon.
ABSTRACT
BACKGROUND: Methemoglobinemia is a potentially life-threatening complication of local anesthetic sprays employed in upper endoscopy. There is limited information available on the incidence of this complication, and no prospective trial has ever undertaken to evaluate subclinical levels of methemoglobinemia. OBJECTIVE: To evaluate the incidence of subclinical methemoglobinemia in patients exposed to anesthetic spray. METHODS: Subjects were randomized to a "spray" or "no-spray" group. Subjects in the "spray" group received a 1-second benzocaine spray before upper endoscopy. All subjects in both groups were monitored with a noninvasive co-oximetry device capable of detecting methemoglobin levels in real time. RESULTS: 401 subjects were enrolled (209 in the study group, 192 in the control group); mean peak methemoglobin concentrations were 0.82% (CI 0.74-0.90%, SD 0.57%) and 0.80% (CI 0.73-0.86%, SD 0.46%) respectively. There was no statistically significant difference between the two groups (p = 0.69). Only 3 (1.4%) subjects in the study group and 2 (1%) subjects in the control group had a peak methemoglobin concentration >2%. CONCLUSIONS: In this randomized clinical trial, no significant elevation of methemoglobin concentration was observed in any subject. Final analysis failed to demonstrate any statistically significant difference between the two groups.
