- The Role of Proton Pump Inhibitors in the Management of Upper Gastrointestinal Disorders. [Journal Article]
- GHGastroenterol Hepatol (N Y) 2018; 14(3):169-175
- Proton pump inhibitors (PPIs) have been in use since the early 1990s and play a crucial role in the management of a number of conditions affecting the upper gastrointestinal tract, including gastroes...
Proton pump inhibitors (PPIs) have been in use since the early 1990s and play a crucial role in the management of a number of conditions affecting the upper gastrointestinal tract, including gastroesophageal reflux disease, Barrett esophagus, eosinophilic esophagitis, and dyspepsia. PPIs also play an important role in the treatment of Helicobacter pylori infection and in the prevention of upper gastrointestinal tract ulcers and bleeding among patients taking antiplatelet therapy and/or nonsteroidal anti-inflammatory drugs. Despite recent concerns regarding the long-term safety of PPIs, their risk-benefit profiles strongly favor their appropriate use in patients who have genuine indications for them. As with all drugs, PPIs should be administered in the lowest effective dose and only for as long as clinically indicated. However, for at least some of their approved indications, PPIs are likely to be required indefinitely. This article outlines the current indications for PPIs for the management of upper gastrointestinal disorders and reviews safety concerns.
- Eosinophilic Esophagitis, Eosinophilic Gastroenteritis, and Eosinophilic Colitis: Common Mechanisms and Differences between East and West. [Review]
- IIInflamm Intest Dis 2016; 1(2):63-69
- Eosinophilic esophagitis (EoE), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EoC) have been diagnosed with an increasing frequency over the last decades. All these diseases share pat...
Eosinophilic esophagitis (EoE), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EoC) have been diagnosed with an increasing frequency over the last decades. All these diseases share pathogenic similarities with respect to triggering by food antigens in the majority of patients once secondary causes of tissue eosinophilia have been excluded. While diagnostic criteria for EoE have been published, the exact criteria for EGE and EoC still need to be defined. This review highlights similarities and differences between affected patients when comparing the Western with the Eastern world.
- Mucosal inflammation in Candida esophagitis has distinctive features that may be helpful diagnostically. [Journal Article]
- MPMod Pathol 2018 Jun 19
- The diagnosis of Candida esophagitis can be challenging when the epithelium containing Candida filamentous forms is not readily seen or is entirely sloughed away. Mucosal inflammation could be helpfu...
The diagnosis of Candida esophagitis can be challenging when the epithelium containing Candida filamentous forms is not readily seen or is entirely sloughed away. Mucosal inflammation could be helpful diagnostically, if distinctive. However it is thought to be nonspecific in Candida esophagitis. The goal of this retrospective study was to identify features of mucosal inflammation helpful in alerting a pathologist to the possibility of Candida esophagitis when Candida mycelia are not readily observed. The study group consisted of 99 consecutive cases of Candida esophagitis and a control group of 64 consecutive cases of reflux esophagitis diagnosed at our institution from 2008-2016. Band-like superficial intraepithelial neutrophils and increased intraepithelial lymphocytes were observed in 75 and 67% of Candida esophagitis cases, respectively and only in 14 and 19% of reflux esophagitis cases, respectively (p < .0001). Intraepithelial lymphocytes were peripapillary or CD4-predominant in 75% of Candida esophagitis cases with increased lymphocytes, in contrast to 17% of reflux esophagitis cases (p = .0011). Concurrent presence of intraepithelial neutrophils and increased lymphocytes showed increased specificity for Candida esophagitis and was observed in 61% of patients with Candida esophagitis and only in 2% of patients with reflux esophagitis (p < .0001). In addition, superficial band-like neutrophils were observed concurrently with increased peripapillary lymphocytes or CD4-predominant lymphocytes in 35 and 50% of Candida esophagitis cases, respectively, in contrast to no reflux esophagitis cases. Basal cell hyperplasia and elongation of stromal papillae were frequent in both groups. The data suggest that when Candida microorganisms are not readily observed, concurrent presence of superficial band-like neutrophils and increased lymphocytes may be indicative of Candida etiology of active esophagitis.
- Possible Risk Factors for Candida Esophagitis in Immunocompetent Individuals. [Journal Article]
- GRGastroenterology Res 2018; 11(3):195-199
- CONCLUSIONS: CE is an opportunistic infection typically seen in immunocompromised. We report incidence of CE in immunocompetent patients. In our cohort of immunocompetent patients, PPI use was the most common risk factor associated with the development of CE. This could be related to hypochlorhydria resulting from PPI use. However, the cause remains unclear in some patients.
- Clinical Effect of Radiotherapy Combined with Chemotherapy for Non-Surgical Treatment of the Esophageal Squamous Cell Carcinoma. [Journal Article]
- MSMed Sci Monit 2018 Jun 19; 24:4183-4191
- CONCLUSIONS: Treating non-surgical ESCC patients with CCRT conferred a significant survival benefit compared with RT alone. CCT after CCRT prolongs PFS but does not increase acute toxicity. High-dose (60-65 Gy) CCRT could generate more favorable survival outcomes.
- The Rise and Rise of Eosinophilic Gut Diseases Including Eosinophilic Esophagitis Is Probably Not Explained by the Disappearance of Helicobacter pylori, so Who or What's to Blame? [Editorial]
- AJAm J Gastroenterol 2018 Jun 18
- A dramatic increase in eosinophilic esophagitis (EoE) and atopic disease and a dramatic decline in Helicobacter pylori infection has been observed in the last few decades. Previously, it was speculat...
A dramatic increase in eosinophilic esophagitis (EoE) and atopic disease and a dramatic decline in Helicobacter pylori infection has been observed in the last few decades. Previously, it was speculated that the immune response to H. pylori may protect against allergic diseases including EoE, but this study by Molina-Infante et al. shows no clear relationship, and suggests that any correlation is not causal. In truth it is likely that a combination of many factors, including a changing microbiome with increasing hygiene and alterations in early life such as antibiotic exposure, changing diet and other lifestyle factors drive increasing atopic diseases including food allergies and EoE.
- What Is the Relationship Between Eosinophilic Esophagitis (EoE) and Aeroallergens? Implications for Allergen Immunotherapy. [Review]
- CACurr Allergy Asthma Rep 2018 Jun 16; 18(8):43
- Observations suggesting that aeroallergens trigger eosinophilic esophagitis (EoE) in a subset of patients raise questions about the implications this finding has on the evaluation and management of p...
Observations suggesting that aeroallergens trigger eosinophilic esophagitis (EoE) in a subset of patients raise questions about the implications this finding has on the evaluation and management of patients with EoE, including a potential role for allergen immunotherapy.
- Heterogeneity in Clinical, Endoscopic, and Histologic Outcome Measures and Placebo Response Rates in Clinical Trials of Eosinophilic Esophagitis: A Systematic Review. [Review]
- CGClin Gastroenterol Hepatol 2018 Jun 13
- CONCLUSIONS: In a systematic review of the literature, we found that no standardized definitions of histologic, endoscopic, or patient-reported outcomes are used to determine whether pharmacologic agents produce a response or remission in patients with EoE. A core outcome set is needed to reduce heterogeneity in outcome reporting and facilitate trial interpretation and comparison of results from trials.
- Esophagitis dissecans superficialis due to severe nonsteroidal anti-inflammatory drugs toxicity. [Letter]
- PMPresse Med 2018 Jun 12
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- Initial Experience of Endoscopic Radiofrequency Waves Delivery to the Lower Esophageal Sphincter (Stretta Procedure) on Symptomatic Gastroesophageal Reflux Disease Post-Sleeve Gastrectomy. [Journal Article]
- OSObes Surg 2018 Jun 15
- CONCLUSIONS: Stretta did not improve GERD symptoms in patients post-LSG at short-term follow-up, and about 6.7% complication rate was reported. Patients were not satisfied despite the decrease in PPI dose.