scholarly journals Eosinophilic esophagitis in children: Updates and practical aspects of management for allergists in a non‐tertiary care private practice setup

2022 ◽  
Vol 43 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Ejaz Yousef ◽  
Yelena Korotkaya ◽  
Alyson B. Simpson
Keyword(s):  
Eosinophilic Esophagitis ◽  
Private Practice ◽  
Immunoglobulin E ◽  
Therapeutic Option ◽  
Tertiary Care ◽  
Elemental Diet ◽  
Dietary Therapy ◽  
Steady Increase ◽  
Esophageal Mucosa

Background: Eosinophilic esophagitis (EoE) is a chronic immune and/or antigen-mediated disease characterized by eosinophilic infiltration of mucosa (≥15 eosinophils per high power field) without any secondary etiology. Non‐immunoglobulin E mediated mechanisms predominate in EoE. Objective: This review concentrated on a stepwise approach for the allergist working in non‐tertiary care private practice. Methods: A medical literature search that focused on several areas of the latest developments in the diagnosis and management of EoE was conducted. Results: There has been a steady increase in the prevalence and incidence of EoE. Clinical symptoms can vary from dysphagia to failure to thrive, depending on the age at presentation; some children develop adaptive behaviors to compensate for dysphagia, such as food preferences and slow eating. The diagnosis is based on a high index of clinical suspicion and is confirmed with endoscopy with biopsies after ruling out other causes of esophageal eosinophilia. Treatment options may include dietary therapy, pharmacologic therapies, or combination therapy. Therapeutic options may also include endoscopic dilation for stricturing disease. Conclusion: Providers should be aware of recent recommendation changes in the diagnostic workup, the role of skin-prick testing, and role of the proton-pump inhibitor as first-line therapy for EoE. Also, clinicians should be aware of the emerging role of empiric dietary therapy as a preferable therapeutic option when compared with the testing-directed diet and the elemental diet. Furthermore, topical glucocorticoid therapies are available, and new developing therapies are being investigated. Reevaluation of esophageal mucosa with biopsies is required approximately 2 months after therapy for a response and after a change in therapies to confirm continued resolution.

scholarly journals Role of Mucosal Inflammation in Eosinophilic Esophagitis: Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Ghulamullah Shahzad ◽  
Paul Mustacchia ◽  
Marianne Frieri
Keyword(s):  
Eosinophilic Esophagitis ◽  
Acid Suppression ◽  
Treatment Modalities ◽  
Mucosal Inflammation ◽  
Esophageal Mucosa ◽  
Immune Mediated ◽  
Acid Suppression Therapy ◽  
Clear Differentiation ◽  
Histological Confirmation

Eosinophilic esophagitis (EE) is increasingly recognized in adults. It is an inflammatory disease of the esophageal mucosa, with variable presentation, unresponsive to acid suppression therapy. The diagnosis requires histological confirmation of intense eosinophilic infiltration on esophageal biopsy specimen, however exact criteria required to make a diagnosis of EE is still being debated and a clear differentiation from gastroesophageal reflux disease (GERD) is important. Allergen elimination or anti-inflammatory therapy may be effective in such patients. The imperfect diagnostic criteria for EE mandate an understanding of the immunology and the pathophysiology of the disease. It may facilitate the introduction of novel treatment modalities in an individual unresponsive to acid suppression therapy. This paper describes basic elements of the immune-mediated injury to the esophageal mucosa and management aspects to provide a better understanding of the condition.

scholarly journals Dietary Management of Eosinophilic Esophagitis: Tailoring the Approach

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1630
Author(s):  
Pierfrancesco Visaggi ◽  
Lucia Mariani ◽  
Veronica Pardi ◽  
Emma Maria Rosi ◽  
Camilla Pugno ◽  
...  
Keyword(s):  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
Immunoglobulin E ◽  
Wheat Gluten ◽  
Skin Tests ◽  
Dietary Therapy ◽  
Dietary Management ◽  
High Power Field ◽  
Advantages And Disadvantages

Eosinophilic esophagitis (EoE) is a unique form of non-immunoglobulin E-mediated food allergy, restricted to the esophagus, characterized by esophageal eosinophil-predominant inflammation and dysfunction. The diagnosis requires an esophago-gastroduodenoscopy with esophageal biopsies demonstrating active eosinophilic inflammation with 15 or more eosinophils/high-power field, following the exclusion of alternative causes of eosinophilia. Food allergens trigger the disease, withdairy/milk, wheat/gluten, egg, soy/legumes, and seafood the most common. Therapeutic strategies comprise dietary restrictions, proton pump inhibitors, topical corticosteroids, biologic agents, and esophageal dilation when strictures are present. However, avoidance of trigger foods remains the only option targeting the cause, and not the effect, of the disease. Because EoE relapses when treatment is withdrawn, dietary therapy offers a long-term, drug-free alternative to patients who wish to remain off drugs and still be in remission. There are currently multiple dietary management strategies to choose from, each having its specific efficacy, advantages, and disadvantages that both clinicians and patients should acknowledge. In addition, dietary regimens should be tailored around each individual patient to increase the chance of tolerability and long-term adherence. In general, liquid elemental diets devoid of antigens and elimination diets restricting causative foods are valuable options. Designing diets on the basis of food allergy skin tests results is not reliable and should be avoided. This review summarizes the most recent knowledge regarding the clinical use of dietary measures in EoE. We discussed endpoints, rationale, advantages and disadvantages, and tailoring of diets, as well as currently available dietary regimens for EoE.

scholarly journals S1072 The Role of Permeability, Inflammation and Proliferation Genes in Adults With Eosinophilic Esophagitis and Their Alteration in Response to Dietary Therapy

2010 ◽  
Vol 138 (5) ◽  
pp. S-172 ◽  
Author(s):  
Nirmala Gonsalves ◽  
Karen Hsu-Blatman ◽  
Ikuo Hirano ◽  
Terrence A. Barrett ◽  
Paul Bryce
Keyword(s):  
Eosinophilic Esophagitis ◽  
Dietary Therapy

Clinical Characteristics of Eosinophilic Esophagitis in Children

2005 ◽  
Vol 114 (11) ◽  
pp. 827-833 ◽  
Author(s):  
Eileen H. Dauer ◽  
Deborah K. Freese ◽  
Mounif El-Youssef ◽  
Dana M. Thompson
Keyword(s):  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Immunoglobulin E ◽  
Clinical Suspicion ◽  
Aerodigestive Tract ◽  
Food Impaction ◽  
Laboratory Findings

Objectives: The role of eosinophilic esophagitis (EE) in aerodigestive tract disorders in children is underestimated and overlooked, primarily because of a lack of understanding of this disorder by otolaryngologists. We sought to better characterize the clinical presentation of EE in order to increase awareness among otolaryngologists. Methods: We retrospectively reviewed 71 children with biopsy-proven EE to determine the most common symptoms and laboratory findings that should increase the clinical suspicion of EE. Results: Dysphagia, food impaction, and emesis were the most common symptoms in children with EE. Asthma was the most common airway diagnosis. Rhinosinusitis was the most common otolaryngological diagnosis. Food allergy was present in 60% of the children tested. Eighty-three percent of the children with elevated immunoglobulin E levels had thick linear streaking or patchy white exudate of the esophagus seen on esophagoscopy. Other major medical comorbidities existed in more than half of the children with EE, of which psychiatric disorders and other disorders of the aerodigestive tract were the most common. Conclusions: Eosinophilic esophagitis may contribute to treatment failure in patients with common and complicated aerodigestive tract disorders. To encourage clinicians to avoid overlooking the diagnosis, we present an evaluative algorithm to increase the suspicion of this entity.

TO DETERMINE THE ROLE OF CA125 IN THE DIAGNOSIS OF ACUTE APPENDICITIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Vinod Kumar ◽  
Bhupen Songra ◽  
Richa Jain ◽  
Deeksha Mehta
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ca 125 ◽  
Care Hospital ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Surgery Department

Background: the present study was under taken to determine the role of CA-125 in the diagnosis of acute appendicitis (AA), to prevent its complications and also in preventing negative appendicectomies in tertiary care hospital. Methods: The study was conducted at a tertiary care and research center between 01/03/2018 to 30/06/2019. Patients admitted to the surgery department with diagnosis of AA were considered for the study. After informed consent, a, standardized history was obtained as a case Performa. Serum samples from all the cases with clinical diagnosis of AA were obtained and stored. Only the cases with histopathologically approved AA were included in the study. Cases operated for clinical diagnosis of AA, but not histopathologically proven AA was not included in the study. CA125 levels in cases with definitive diagnosis of AA were measured. Results: In present study, ROC curve analysis revealed the sensitivity of 87.27 % and specificity of 90.91 % when the CA 125 cut-off value of > 16.8 was taken to diagnose acute appendicitis. AUC was 0.911 with a standard error of 0.0292. Conclusion: In this study we have observed that CA125 showed a positive correlation with acute appendicitis, that was statistically not significant (P>0.05). We didn’t evaluate the correlation with the disease severity. We consider that CA125 can be used as a marker in acute appendicitis cases although further research is still needed. Keywords: CA125, Acute Appendicitis, Surgery.

Reward Prediction Errors Drive Declarative Learning Irrespective of Agency

2020 ◽  
Author(s):  
Kate Ergo ◽  
Luna De Vilder ◽  
Esther De Loof ◽  
Tom Verguts
Keyword(s):  
Learning Theory ◽  
Learning Effect ◽  
Steady Increase ◽  
Prediction Errors ◽  
Experimental Paradigm ◽  
Reward Prediction ◽  
Declarative Learning

Recent years have witnessed a steady increase in the number of studies investigating the role of reward prediction errors (RPEs) in declarative learning. Specifically, in several experimental paradigms RPEs drive declarative learning; with larger and more positive RPEs enhancing declarative learning. However, it is unknown whether this RPE must derive from the participant’s own response, or whether instead any RPE is sufficient to obtain the learning effect. To test this, we generated RPEs in the same experimental paradigm where we combined an agency and a non-agency condition. We observed no interaction between RPE and agency, suggesting that any RPE (irrespective of its source) can drive declarative learning. This result holds implications for declarative learning theory.

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