Allergy assessment in children with eosinophilic esophagitis.

BACKGROUND: Eosinophilic esophagitis (EoE) is of growing interest for pediatricians and allergists. There is no general agreement about diagnostic and clinical management procedures. The objective of this prospective, observational study was to evaluate the efficacy of a protocol for the etiologic diagnosis and accurate treatment of EoE in the pediatric population. PATIENTS AND METHODS: Starting in 2001, patients aged 0 to 14 years with a diagnosis of EoE were consecutively included in a protocol which included an allergy study. Depending on the results, an avoidance or elemental diet was established. Topical corticosteroids were prescribed to patients who rejected the diet. Clinical, endoscopic, and histological evaluation was performed to assess response. In the case of disease remission, challenge tests were performed to identify the offending food. RESULTS: Seventeen patients were included. Most of them were male (14/17) and a high percentage (88%) had a history of allergy as well as a history of atopy in parents. Fifteen patients were sensitized to 1 or more foods. With this protocol and the subsequent treatment, 9 out of 17 patients were cured (1 out of 4 with swallowed corticosteroids, 3 out of 3 with an elemental diet, and 5 out of 12 with an avoidance diet). The offending food was identified in 8117 patients. Milk and eggs were the most common foods implicated. CONCLUSIONS: The allergy study was a useful diagnostic tool but it was not sufficient to identify the offending food.An elemental diet should be attempted before food is excluded as the cause of the disease.

“Enfermedad de las tres mentiras”: síndrome de la úlcera rectal solitaria / “The three-lies disease”: Solitary rectal ulcer syndrome

El síndrome de la úlcera rectal solitaria es una entidad benignapoco común cuyos síntomas más frecuentes son la rectorragia y eldolor anal. Los hallazgos anatomopatológicos son típicos. Se sueleevidenciar engrosamiento de la mucosa, elongación y distorsiónde las glándulas, una lámina propia edematosa con gran cantidadde colágena y engrosamiento de la muscularis mucosae. El diagnósticose realiza mediante endoscopia con toma de biopsias. Nosiempre se trata de lesiones ulceradas. Se suele localizar preferentementeen la cara rectal anterior y/o lateral, aunque hasta un30% de las lesiones son múltiples, existiendo casos de afectacióndel colon sigmoide y descendente. Por tanto, la presentación puedeser heterogénea y este es el motivo por el que esta entidad estambién conocida como la “enfermedad de las tres mentiras”.Presentamos un caso de síndrome de la ulcera rectal solitaria manifestadoendoscópicamente como una placa eritematosa localizadaen la cara lateral izquierda del recto

Solitary rectal ulcer syndrome is an uncommon benign conditioncharacterized by rectal bleeding, passage of mucus, and pain.Histological features are well established as obliteration of thelamina propria by fibrosis and smooth-muscle fibers extendingfrom a thickened muscularis mucosa to the lumen. Diagnosis canusually be made on sigmoidoscopy, and biopsies should always betaken. Ulceration is not universally present, and polypoid, non-ulceratedlesions and erythematous areas are also seen. The lesionor lesions are most often found on the anterior or anterolateralwall of the rectum, although they can also be located in the leftcolon and be more extensive or even circumferential. Lesions aremultiple in 30 percent of cases. These are the reasons why thisentity is also known as “the disease of three lies”. We report acase of solitary rectal ulcer syndrome presenting at endoscopywith an erythematous area on the left side wall of the rectum (AU)

["The three-lies disease": solitary rectal ulcer syndrome]. / "Enfermedad de la tres mentiras": síndrome de la úlcera rectal solitaria.

Solitary rectal ulcer syndrome is an uncommon benign condition characterized by rectal bleeding, passage of mucus, and pain. Histological features are well established as obliteration of the lamina propria by fibrosis and smooth-muscle fibers extending from a thickened muscularis mucosa to the lumen. Diagnosis can usually be made on sigmoidoscopy, and biopsies should always be taken. Ulceration is not universally present, and polypoid, non-ulcerated lesions and erythematous areas are also seen. The lesion or lesions are most often found on the anterior or anterolateral wall of the rectum, although they can also be located in the left colon and be more extensive or even circumferential. Lesions are multiple in 30 percent of cases. These are the reasons why this entity is also known as "the disease of three lies". We report a case of solitary rectal ulcer syndrome presenting at endoscopy with an erythematous area on the left side wall of the rectum.

[Vascular involvement of the colon in a patient with chronic hepatitis C virus infection]. / Afectación vasculítica del colon en un paciente con infección crónica por el virus de la hepatitis C.

We describe a case of vasculitis with colonic involvement/alterations associated with hepatitis C virus infection. Both the association of hepatitis C with vasculitis type periarteritis nodosa and the prominent involvement of the colon are infrequent. The presentation of this case--fever of unknown origin--as well as the difficulties of treating a patient who is a hepatitis C virus carrier are discussed.