Skin testing-guided elimination diet has proved unsuccessful for adult eosinophilic oesophagitis (EoE), whereas empiric six-food elimination diet (SFED) achieves an efficacy of 70%.
To compare the ...efficacy of food-specific serum IgE-targeted elimination diet (sIgE-ED) and SFED.
Prospective study in adult patients with EoE. Food-specific serum IgE, skin prick test (SPT) and atopy patch test (APT) to foods included in SFED were performed. Those with ≥1 positive IgE test, defined by ≥0.1 kU/l, followed a 6-week sIgE-ED, whereas non-IgE-sensitized patients underwent a 6-week SFED. Responders to diet (<15 eos/HPF) underwent individual reintroduction of foods followed by histological assessment.
Forty-three EoE patients were included (26 sIgE-ED and 17 SFED). Regarding sIgE-ED, the mean number of eliminated foods per patient was significantly lower than in SFED (3.81 vs 6; P < 0.001), being wheat (85%), nuts (73%) and cow's milk (61%) the most commonly foods withdrawn. No difference in histological response was observed between sIgE-ED and SFED (73% vs 53%, P = 0.17). Causative foods identified by food challenge were cow's milk (64%), wheat (28%), egg (21%) and legumes (7%), with a single food trigger in 71% of patients. sIgE exhibited the higher accuracy to predict offending foods in IgE-sensitized patients (sensitivity 87.5%, specificity 68% (κ = 0.43)), with k values of 1 for cow's milk. APT results were all negative.
Histological remission was accomplished in 73% of patients undergoing sIgE-ED, which was nonsignificantly superior to SFED. sIgE effectively identified cow's milk as a food trigger in IgE-sensitized patients.
Summary
Background
Conflicting results have been recently reported for the accuracy of the Endoscopic Reference Score (EREFS), an standardised endoscopic classification, to predict the histological ...activity of eosinophilic oesophagitis (EoE).
Aim
To evaluate the accuracy of the EREFS to predict either histological or clinical activity of EoE.
Methods
Prospective multicentre study conducted in eight Spanish centres evaluating adult EoE patients, either naïve or after treatment. Symptoms were evaluated before upper endoscopy through the Dysphagia Symptom Score, whereas researchers scored the EREFS immediately after the endoscopic procedure, unaware of the histological outcome.
Results
One hundred and forty‐five EoE patients undergoing 240 consecutive endoscopic procedures were included. Exudates (P = 0.03), furrows (P = 0.03) and a composite score of inflammatory signs (exudates, furrows and oedema) (P < 0.001) accurately predicted histological activity. Exudates were the only endoscopic sign showing a good correlation with histological outcome after therapy. Furrows and oedema persisted in 50% and 70% of patients despite histological remission. No endoscopic feature exceeded 70% accuracy to predict histological activity. Likewise, no endoscopic finding could adequately predict dysphagia severity. Crepe paper mucosa, diffuse exudates and severe rings correlated with higher symptom scores.
Conclusions
Endoscopic findings assessed by the Endoscopic Reference Score did not correlate with histological or clinical disease activity in adult EoE patients. Only exudates correlated with peak eosinophil count and histological outcome, whereas furrows and oedema persisted in over half of patients despite histological remission.
Resumen Antecedentes La impactación esofágica por bolo alimenticio es un síntoma de debut en pacientes diagnosticados de esofagitis eosinofílica, lo cual supone un cambio en la epidemiología y el ...manejo de esta urgencia. Objetivo Detectar factores predictores de esofagitis eosinofílica en pacientes con impactación esofágica por bolo alimenticio. Métodos Se analizaron de forma retrospectiva pacientes atendidos por impactación por cuerpo extraño. Se estudiaron las características epidemiológicas, los hallazgos endoscópicos y los antecedentes de impactación. El análisis estadístico se realizó mediante los test de la t de Student y de la χ2 . Se elaboró un modelo de regresión logística. Resultados Ciento treinta y un pacientes, 65% varones, con una edad media de 56 años. En los pacientes con impactación por bolo alimenticio (n = 89), la sospecha endoscópica de esofagitis eosinofílica fue el hallazgo más frecuente. De estos, aquellos sin confirmación histológica fueron excluidos (n = 7); el resto de los pacientes (n = 82) se dividió en 2 grupos: esofagitis eosinofílica confirmada (grupo A) (n = 18) y otros hallazgos endoscópicos (grupo B) (n = 64). El grupo A presentaba una menor edad media (36.47 vs. 64.45; p = 0.001) e historia de impactación previa más frecuente que el grupo B (38 vs. 6%; OR = 15.70; IC del 95%, 3.60-62.50; p = 0.001). Edad e historia de impactación se comportaron como predictores de esofagitis eosinofílica con una sensibilidad del 82%, una especificidad del 80% y un rendimiento del 84% (p < 0.001). Conclusión Edad y antecedentes de impactación predicen la presencia de esofagitis eosinofílica en pacientes con impactación por bolo alimenticio.
Familial amyloidotic polyneuropathy is an inherited form of amyloidosis associated with a mutant form of a protein called transthyretin. The Methionine‐30 variant is the most frequent mutation ...observed. This disorder is caused by deposition of this protein as amyloid in several organs, such as the heart, kidneys, and peripheral nervous system. The disease is always progressive and fatal, and patients die 7 to 10 years after the onset of symptoms. Liver transplantation is at present the only choice for these patients because it provides improvement of symptoms and/or stops progression of the disease in most patients. We report the case of a patient who showed clear progression of cardiomyopathy and neuropathy after liver transplantation.
Food bolus esophageal impaction is often the first symptom in patients diagnosed with eosinophilic esophagitis, representing a change in the epidemiology and management of this urgency.
To detect ...eosinophilic esophagitis predictive factors in patients with esophageal impaction due to food bolus.
Patients seen for foreign body impaction were retrospectively analyzed. Epidemiologic characteristics, endoscopic findings, and impaction history were studied. The statistical analysis was carried out using the Student's t test and the chi square test and a logistic regression model.
Of the 131 patients, 65% were men and the mean age was 56 years. The endoscopic suspicion of eosinophilic esophagitis was the most frequent finding in patients with food bolus impaction (n=89); those patients that did not have histologic confirmation were excluded (n=7). The remaining patients (n=82) were divided into two groups: confirmed eosinophilic esophagitis (Group A) (n=18) and other endoscopic findings (Group B) (n=64). Group A presented with a lower mean age (36.47 vs. 64.45, P=.001) and a more frequent past history of impaction (38% vs. 6%, OR=15.70, 95% CI (3.60-62.50), P=.001) than Group B. Age and impaction history acted as predictors for eosinophilic esophagitis with 82% sensitivity, 80% specificity, and 84% diagnostic accuracy (P<.001).
Age and a history of impaction predict the presence of eosinophilic esophagitis in patients with food bolus impaction.
Abstract
Background
Skin testing‐guided elimination diet has proved unsuccessful for adult eosinophilic oesophagitis (
E
o
E
), whereas empiric six‐food elimination diet (
SFED
) achieves an efficacy ...of 70%.
Objective
To compare the efficacy of food‐specific serum
I
g
E
‐targeted elimination diet (
sIgE
‐
ED
) and
SFED
.
Methods
Prospective study in adult patients with
E
o
E
. Food‐specific serum
I
g
E
, skin prick test (
SPT
) and atopy patch test (
APT
) to foods included in
SFED
were performed. Those with ≥1 positive IgE test, defined by ≥0.1 kU/l, followed a 6‐week
sIgE
‐
ED
, whereas non‐IgE‐sensitized patients underwent a 6‐week SFED. Responders to diet (<15 eos/HPF) underwent individual reintroduction of foods followed by histological assessment.
Results
Forty‐three EoE patients were included (26
sIgE
‐
ED
and 17
SFED
). Regarding
sIgE
‐
ED
, the mean number of eliminated foods per patient was significantly lower than in SFED (3.81
vs
6;
P
< 0.001), being wheat (85%), nuts (73%) and cow's milk (61%) the most commonly foods withdrawn. No difference in histological response was observed between
sIgE
‐
ED
and
SFED
(73%
vs
53%,
P
= 0.17). Causative foods identified by food challenge were cow's milk (64%), wheat (28%), egg (21%) and legumes (7%), with a single food trigger in 71% of patients.
sIgE
exhibited the higher accuracy to predict offending foods in IgE‐sensitized patients (sensitivity 87.5%, specificity 68% (
κ
= 0.43)), with
k
values of 1 for cow's milk. APT results were all negative.
Conclusions
Histological remission was accomplished in 73% of patients undergoing
sIgE
‐ED, which was nonsignificantly superior to
SFED
.
sIgE
effectively identified cow's milk as a food trigger in IgE‐sensitized patients.
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