Diagnosing and Treating Eosinophilic Esophagitis

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LETTER FROM THE EDITOR Diagnosing and Treating Eosinophilic Esophagitis osinophilic esophagitis, a chronic inflamma- In our Advances in IBS column, Dr Michael tory disorder of the esophagus characterized by Camilleri examines medical treatments for patients with an esophageal eosinophilic infiltrate and other irritable bowel syndrome. Among other issues, he dis- Eesophageal symptoms, is increasing in prevalence world- cusses the therapeutic agents currently available to treat wide. This disorder is also one of the most common this condition, why new therapies are still needed, the causes of dysphagia and food impactions globally. In a various agents presently being investigated, trial data on feature article in this month’s issue of Gastroenterology safety and adverse effects, the role of bile acids, and chal- & Hepatology, Dr Anna M. Lipowska and Dr Robert T. lenges associated with drug development. Kavitt explore the diagnostic and treatment strategies Therapeutic drug monitoring of inflammatory currently available for this condition. The authors discuss bowel disease patients taking biologic therapy is the endoscopic and histologic evaluation, the role of proton focus of our Advances in IBD column. Dr Adam pump inhibitors, and the use of other diagnostic tools, Cheifetz discusses why therapeutic drug monitoring as well as dietary therapies (including elemental diet, is important in this setting, when drug concentrations allergy testing–directed elimination diet, and empiric should be measured, study data on reactive therapeutic elimination diet), topical and systemic corticosteroids, drug monitoring as well as on proactive therapeutic drug endoscopic dilation, and various pharmacologic experi- monitoring, and the challenges associated with these mental therapies. methods, among other issues. Another feature article examines the black box warn- Finally, in our Advances in Hepatology column, Dr ing for potential reactivation of hepatitis B virus during Marcelo Kugelmas examines nonliver-related benefits the use of direct-acting antiviral therapy in patients with associated with obtaining sustained virologic response in chronic hepatitis C virus infection. Dr Paul J. Pockros patients with hepatitis C virus infection. He discusses describes initial and recent reports of hepatitis B virus how, in addition to stopping inflammation and fibrosis, reactivation, the resulting effects on initiating and moni- sustained virologic response can lead to improvements toring treatment (including the recent black box warning in quality of life, diabetes and insulin resistance, cryo- on all direct-acting antiviral drugs and combinations), globulinemia, renal disease, lymphoma risk, cardiovas- and how society guidelines have been updated. cular disease, and cerebrovascular disease. This month’s Advances in Endoscopy column I hope you enjoy these articles and find them clini- focuses on endoscopic sleeve gastroplasty. Dr Reem cally useful. Sharaiha discusses issues such as the procedure’s role in the management of obesity, how it is performed, its Sincerely, effectiveness in the long term, and its associated adverse events. She also describes the ideal candidate and com- pares the procedure to other endoscopic and surgical options for managing obesity. Gary R. Lichtenstein, MD, AGAF, FACP, FACG 522 Gastroenterology & Hepatology Volume 13, Issue 9 September 2017.

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Clinic Offers a Comprehensive Approach to Immune-Mediated Digestive Diseases
Clinic offers a comprehensive approach to immune-mediated digestive diseases Treating a wide range of disorders “Our team designed this clinic to treat a wide range of allergic and immune-mediated gastrointestinal diseases,” says Laura Wozniak, MD, MS, co-director of the UCLA Pediatric Celiac Disease & Eosinophilic Esophagitis Clinic and assistant clinical professor of pediatric gastroenterology. “These conditions can be quite variable in terms of symptoms and management, which makes it important to involve an experienced, multidisciplinary team. UCLA is one of only a few centers across the country with a dedicated team to do just that.” The Pediatric Celiac Disease & Through collaboration among Pediatric Gastroenterology, Allergy & Immunology, Eosinophilic Esophagitis Clinic and Nutrition, the new Pediatric Celiac Disease & Eosinophilic Esophagitis Clinic at Mattel Children’s Hospital at Mattel Children’s Hospital UCLA offers comprehensive patient-centered care for UCLA sees patients with a wide children across a wide range of immune-mediated digestive diseases. It is the only range of disorders including: multidisciplinary clinic of its kind in Southern California. • Celiac disease and gluten sensitivity Immune-mediated digestive diseases • Eosinophilic esophagitis Celiac disease (CD) and eosinophilic esophagitis (EoE) are two of the more common and gastroenteritis allergic and immune-mediated digestive diseases among a diverse group of conditions • Food allergy and food sensitivity that affect the gastrointestinal (GI) tract. These disorders, which often develop in early • Food protein-induced childhood and require a lifetime of vigilant management, have been on the rise over enterocolitis syndrome (FPIES) the past decade although the underlying pathogenesis remains poorly understood. • Food protein intolerance (e.g., Symptoms can be nonspecific, and a lack of targeted testing and clinical biomarkers cow’s milk protein intolerance) cause the disorders to often go unrecognized or misdiagnosed.
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Clinical and Psychological Impact of COVID-19 Infection in Adult Patients with Eosinophilic Gastrointestinal Disorders During the SARS-Cov-2 Outbreak
Journal of Clinical Medicine Article Clinical and Psychological Impact of COVID-19 Infection in Adult Patients with Eosinophilic Gastrointestinal Disorders during the SARS-CoV-2 Outbreak Edoardo Vincenzo Savarino 1,* , Paola Iovino 2 , Antonella Santonicola 2 , Matteo Ghisa 1 , Giorgio Laserra 1, Brigida Barberio 1, Daria Maniero 1, Greta Lorenzon 1, Carolina Ciacci 2 , Vincenzo Savarino 3 and Fabiana Zingone 1 1 Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy; [email protected] (M.G.); [email protected] (G.L.); [email protected] (B.B.); [email protected] (D.M.); [email protected] (G.L.); [email protected] (F.Z.) 2 Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy; [email protected] (P.I.); [email protected] (A.S.); [email protected] (C.C.) 3 Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16126 Genoa, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-049-8217749 Received: 4 June 2020; Accepted: 23 June 2020; Published: 26 June 2020 Abstract: Eosinophilic gastrointestinal diseases (EGIDs) are chronic gastrointestinal conditions requiring corticosteroid and immunosuppressive therapy for disease control. Patients with EGIDs usually report impaired quality of life. We aimed to report the clinical and psychological impact of COVID-19 infection in EGID patients. In this prospective web-based study we invited all consecutive EGID patients attending the University Hospital of Salerno (Campania) and Padua (Veneto) to ﬁll an ad hoc COVID-19 survey. Moreover, a telemedicine service for direct consultation was organized.
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Hiatal Hernias in Patients with GERD-Like Symptoms: Evaluation of Dynamic Real-Time MRI Vs Endoscopy
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Eosinophilic Gastrointestinal Disorders
Clinical Reviews in Allergy & Immunology (2019) 57:272–285 https://doi.org/10.1007/s12016-019-08732-1 Eosinophilic Gastrointestinal Disorders Nirmala Gonsalves1 Published online:22 March 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Eosinophilic gastrointestinal disorders (EGID) are a group of disorders characterized by pathologic eosinophilic infiltration of the esophagus, stomach, small intestine, or colon leading to organ dysfunction and clinical symptoms (J Pediatr Gastroenterol Nutr; Spergel et al., 52: 300–306, 2011). These disorders include eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosino- philic gastroenteritis (EGE), eosinophilic enteritis (EE), and eosinophilic colitis (EC). Symptoms are dependent not only on the location (organ) as well as extent (layer invasion of the bowel wall). Common symptoms of EoE include dysphagia and food impaction in adults and heartburn, abdominal pain, and vomiting in children. Common symptoms of the other EGIDs include abdominal pain, nausea, vomiting, early satiety, diarrhea, and weight loss. These disorders are considered immune-mediated chronic inflammatory disorders with strong links to food allergen triggers. Treatment strategies focus on either medical or dietary therapy. These options include not only controlling symptoms and bowel inflammation but also on identifying potential food triggers. This chapter will focus on the clinical presentation, pathophysiology, and treatment of these increasingly recognized disorders. Keywords Eosinophilic gastroenteritis . Eosinophilic gastritis . Eosinophilic esophagitis . Dysphagia . Food impaction . Food allergy Introduction purpose of this chapter, we will discuss these disorders sepa- rately and focus on the available data on the clinical presenta- Eosinophilic gastrointestinal disorders (EGID) are a group of tion, pathophysiology, and treatment. disorders characterized by pathologic eosinophilic infiltration of the esophagus, stomach, small intestine, or colon leading to organ dysfunction and clinical symptoms [1].
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Eosinophilic Peritonitis in a Patient with Liver Cirrhosis: a Case Report
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