Search

The article provides an updated algorithm for diagnosing and treating eosinophilic esophagitis (EoE) in adults, a chronic inflammatory disease of the esophagus. Diagnosis involves esophagogastroduodenoscopy and detection of eosinophils in esophageal biopsies, with consideration of EoE variants. Treatment options include proton-pump inhibitors, topical corticosteroids, and elimination diets, with regular monitoring and potential use of Dupilumab for refractory cases. Long-term follow-up and maintenance treatment are recommended for all patients with EoE. The research was supported by various grants and foundations, with potential conflicts of interest disclosed by the authors. [Extracted from the article]

The editorial discusses the evolving treatment approaches for inflammatory bowel disease (IBD), emphasizing the importance of achieving mucosal healing and considering the possibility of reducing or stopping medications once this goal is reached. A study conducted in South Korea found that discontinuing 5‐aminosalicylic acid (5‐ASA) after initiating anti-TNF agents did not lead to an inferior outcome over a 4.3-year follow-up period. While cost savings from stopping 5-ASA were significant, the potential chemopreventive effect of 5-ASA in reducing the risk of IBD-associated colorectal cancer remains a topic for further investigation. The editorial highlights the ongoing debate on whether to stop or continue 5-ASA treatment in well-controlled patients. [Extracted from the article]

Objective: Physicians are increasingly confronted with patients presenting with symptoms of esophageal dysfunction resembling eosinophilic esophagitis (EoE), but absence of significant esophageal eosinophilia. The purpose of this study was to characterize and classify this group of EoE variants. Design: Patients from six EoE‐centers with symptoms of esophageal dysfunction, but peak eosinophil counts of <60/mm2 (<15/hpf) in esophageal biopsies and absence of gastro‐esophageal reflux disease (GERD) were included. Clinical, endoscopic, (immuno)‐histological, and molecular features were determined and compared with EoE, GERD, and healthy controls. Results: We included 69 patients with EoE variants. Endoscopic abnormalities were found in 53.6%. We identified three histological subtypes: EoE‐like esophagitis (36/69, 52.2%), lymphocytic esophagitis (14/69, 20.3%), and non‐specific esophagitis (19/69, 27.5%). Immunohistochemistry revealed—in contrast to EoE—no significant increase in inflammatory cell infiltrates compared with GERD and healthy controls, except for lymphocytes in lymphocytic esophagitis. EoE‐typical Th2‐response was absent in all EoE variants. However, considerable structural changes were detected based on histology and protein expression. Using next generation mRNA sequencing, we found the three EoE variants to have distinct molecular fingerprints partially sharing pronounced traits of EoE. Hierarchical sample clustering of RNA sequencing data confirmed the presence of an EoE‐like (characterized by eotaxin‐3 expression), non‐specific, and lymphocytic variant cluster (characterized by CD3 cells and TSLP expression). Conclusion: All EoE variants are clinically and histologically active conditions despite the absence of esophageal eosinophilia. EoE variants appear to be part of a disease spectrum, where classical EoE represents the most common and apparent phenotype. [ABSTRACT FROM AUTHOR]

Copyright of British Journal of Pharmacology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Background: Inflammatory bowel disease (IBD) can be exacerbated by stress and depression. Type D personality, characterised by high negative affectivity and social inhibition, represents a vulnerability towards stressors and is associated with adverse outcomes in coronary heart disease. Aims: To assess the prevalence of Type D personality in IBD patients and investigate potential associations with disease course. Methods: We tested for associations between Type D (Type DScale‐14), depressive symptoms (Hospital Anxiety and DepressionScale's depression subscore ≥11) and recurrent IBD amongst Swiss IBD cohort patients. We built regression models for cross‐sectional and Cox proportional hazards models for time‐to‐event analyses. IBD disease course was assessed by the future occurrence of active disease (Crohn's Disease ActivityIndex ≥150/Modified Truelove & Witts activity index ≥10) and several IBD‐relevant endpoints. Results: Amongst 2275 patients (1005 ulcerative colitis, 1270 Crohn's disease), 672 (29.5%) had Type D. Type D was a significant risk factor for future active disease (adjusted hazard ratio, aHR: 1.60, corrected P value, q = 0.007) and predicted the future presence of depressive symptoms (aHR: 3.30, P < 0.001). The combination of Type D and depressive symptoms further increased the risk for active disease (aHR: 3.98, q < 0.001). However, Type D associated depressive symptoms seemed to be the main contributor to this effect as Type D's predictive power decreased considerably in models corrected for depressive symptoms (aHR: 1.32, CI: 0.97‐1.79, q = 0.292). Conclusions: Type D personality's prevalence amongst IBD patients was comparable with its prevalence in the general population. Type D was strongly associated with depressive symptoms and showed modest independent associations with IBD prognosis. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is the main symptom of adult eosinophilic esophagitis (EoE). We describe a novel syndrome, referred to as "food‐induced immediate response of the esophagus" (FIRE), observed in EoE patients. Methods: Food‐induced immediate response of the esophagus is an unpleasant/painful sensation, unrelated to dysphagia, occurring immediately after esophageal contact with specific foods. Eosinophilic esophagitis experts were surveyed to estimate the prevalence of FIRE, characterize symptoms, and identify food triggers. We also surveyed a large group of EoE patients enrolled in the Swiss EoE Cohort Study for FIRE. Results: Response rates were 82% (47/57) for the expert and 65% (239/368) for the patient survey, respectively. Almost, 90% of EoE experts had observed the FIRE symptom complex in their patients. Forty percent of EoE patients reported experiencing FIRE, more commonly in patients who developed EoE symptoms at a younger age (mean age of 46.4 years vs 54.1 years without FIRE; P <.01) and in those with high allergic comorbidity. Food‐induced immediate response of the esophagus symptoms included narrowing, burning, choking, and pressure in the esophagus appearing within 5 minutes of ingesting a provoking food that lasted less than 2 hours. Symptom severity rated a median 7 points on a visual analogue scale from 1 to 10. Fresh fruits/vegetables and wine were the most frequent triggers. Endoscopic food removal was significantly more commonly reported in male patients with vs without FIRE (44.3% vs 27.6%; P =.03). Conclusions: Food‐induced immediate response of the esophagus is a novel syndrome frequently reported in EoE patients, characterized by an intense, unpleasant/painful sensation occurring rapidly and reproducibly in 40% of surveyed EoE patients after esophageal contact with specific foods. [ABSTRACT FROM AUTHOR]

Eosinophilic esophagitis (EoE) is a chronic-inflammatory disease of the esophagus, defined I clinically i by the presence of symptoms of esophageal dysfunction and I histologically i by an eosinophil predominant infiltration in the esophageal mucosa.[1] Due to its chronicity, EoE requires both short-term and long-term treatments.[2] Therapeutic goals are (a) to control clinical activity (resolution of symptoms); and (b) to control biological activity to avoid stricture formation and bolus impaction, a potentially life-threatening event. Treatment of EoE consists of the 3 D's: Drugs, Diet, and Dilation.[2] Dilation should be seen as an add-on treatment since it does not affect underlying inflammation (Figure). Most importantly, any therapy should be maintained as cessation of treatment results in an EoE relapse within only few months.[11] If histological response is not achieved, we recommend switching from PPI ("PPI non-response") or elimination diet to STC. [Extracted from the article]

The cover image is based on the Original Article Type D personality is associated with depressive symptoms and clinical activity in inflammatory bowel disease by Sebastian Bruno Ulrich Jordi et al., https://doi.org/10.1111/apt.16365. The cover image was created with BioRender.com by Jara Filippini. [ABSTRACT FROM AUTHOR]