ABSTRACT
Background: Diagnosis and management of eosinophilic esophagitis (EoE) occur via esophagogastroduodenoscopy with tissue biopsy. Objective: We sought to determine if salivary microribonucleic acid (miRNA) levels could differentiate children with EoE, serving as a noninvasive biomarker. Methods: Saliva was collected from children undergoing esophagogastroduodenoscopy (N = 291). miRNA analysis was conducted on 150 samples: EoE (n = 50), no pathologic alteration (n = 100). RNA was quantified with high throughput sequencing and aligned to build hg38 of the human genome using sequencing and alignment software. Quantile normalized levels of robustly expressed miRNAs (raw counts > 10 in 10% of samples) were compared across EoE and non-EoE groups with Wilcoxon rank sum testing. miRNA biomarker candidates were selected based on variable importance projection (VIP) scoring with partial least squared discriminant analysis (VIP > 1.5). Ability of these miRNAs to differentiate EoE status was assessed via logistic regression. Putative biologic targets for the miRNA candidates were determined in miRNA pathway analysis software. Results: Of the 56 salivary miRNAs reliably detected, miR-205-5p displayed the largest difference between EoE and non-EoE groups (V = 1623, adjusted p = 0.029). Six miRNAs (miR-26b-5p, miR-27b-3p, Let-7i-5p, miR-142-5p, miR-30a-5p, miR-205-5p) displayed elevated VIP scores (>1.5) and were able to differentiate EoE samples on logistic regression analysis with 70% sensitivity and 68% specificity. These six miRNAs demonstrated significant enrichment for gene targets involved in valine, leucine, and isoleucine biosynthesis (p = 0.0012), 2-oxycarboxylic acid metabolism (p = 0.043), and steroid hormone biosynthesis (p = 0.048). Conclusions: Salivary miRNAs represent a noninvasive, biologically relevant measure that may aid disease monitoring of EoE.
Subject(s)
Eosinophilic Esophagitis , MicroRNAs , Humans , Child , BiopsyABSTRACT
We report 3 adolescents with cannabis hyperemesis syndrome and recurrent hypophosphatemia complicating their clinical course with potential for significant consequences. They serve as reminders for providers to consider the diagnosis of cannabis hyperemesis syndrome and to monitor serum electrolytes closely in the setting of adolescent hyperemesis.
ABSTRACT
Over the past 2 decades, eosinophilic esophagitis (EoE) has become increasingly recognized as a common cause of gastrointestinal morbidity in children. A mainstay of treatment is food avoidance, which must be implemented in both the home and school settings for school-aged children. The aim of this study is to assess school nurses' familiarity with EoE with regard to food avoidance and treatment in the school setting. We conducted a 19-question online survey of 60 school nurses (elementary through high school) recruited from Dauphin, Lebanon, and Lancaster Counties in Pennsylvania. Results indicated that 62% of respondents were familiar with EoE. However, only 22% felt comfortable distinguishing between symptoms of EoE and food-dependent anaphylaxis. Almost all respondents (97%) were interested in learning more about EoE. We report significantly increased familiarity with food-dependent anaphylaxis in comparison with EoE among school nurses. There is an interest and need for increasing education on EoE.
Subject(s)
Anaphylaxis , Eosinophilic Esophagitis , Food Hypersensitivity , Nurses , Child , Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/etiology , Eosinophilic Esophagitis/therapy , Food Hypersensitivity/diagnosis , Humans , Needs AssessmentSubject(s)
Anxiety/psychology , Eosinophilic Esophagitis/psychology , Food Hypersensitivity/psychology , Parents/psychology , Adolescent , Anxiety/classification , Anxiety/physiopathology , Child , Comprehension , Cross-Sectional Studies , Eosinophilic Esophagitis/immunology , Eosinophilic Esophagitis/pathology , Eosinophils/immunology , Eosinophils/pathology , Esophagus/immunology , Esophagus/pathology , Female , Food Hypersensitivity/immunology , Food Hypersensitivity/pathology , Humans , Immunoglobulin E/blood , Male , Pilot Projects , Quality of Life , Tertiary Care CentersSubject(s)
Cholangiopancreatography, Endoscopic Retrograde/methods , Pancreatic Ducts/surgery , Pancreatitis, Chronic/complications , Child , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Humans , Male , Pancreatic Ducts/pathology , Pancreatitis, Chronic/surgery , Stents , Ultrasonography, InterventionalABSTRACT
A bezoar is a mass of indigestible material. Bezoars can present with a gradual onset of non-specific gastrointestinal symptoms including abdominal pain, nausea and vomiting. However, bezoars can result in more serious conditions such as intestinal bleeding or obstruction. Without quick recognition, particularly in susceptible individuals, the diagnosis and treatment can be delayed. Currently resolution is achieved with enzymatic dissolution, endoscopic fragmentation or surgery. We describe, to our knowledge, the first pediatric patient with lymphoma to have had a bezoar treated with Coca-Cola.
