Explore the vast range of titles available.

INTRODUCTION:Lymphocytic esophagitis (LyE) and eosinophilic esophagitis (EoE) are immune-mediated esophageal diseases. Clinical characteristics, endoscopic findings, and treatment outcomes of LyE were compared with EoE.METHODS:This was an international retrospective study on adults enrolled at 3 centers in Europe. We recorded clinical characteristics and endoscopy findings at baseline and symptoms, histology, and endoscopy outcomes after treatment of patients with LyE and EoE.RESULTS:Demographics, clinical presentation, comorbidities, and endoscopy findings were largely different in 35 patients with LyE compared with 59 patients with EoE. Proton pump inhibitor response was generally lower in LyE.DISCUSSION:LyE is clinically different from EoE, but differences in treatment response need further investigation.

We investigated whether dilation modifies the association between symptoms and esophageal eosinophilia (peak esophageal eosinophils/high-power field [eos/hpf]) in patients with eosinophilic esophagitis enrolled into a randomized trial comparing the efficacy of budesonide and fluticasone. Baseline Dysphagia Symptom Questionnaire and Eosinophilic Esophagitis Activity Index were available in 102 and 73 patients, respectively, of whom 56 and 39 underwent dilation at screening endoscopy before symptom assessment. The pair-wise relationship between Dysphagia Symptom Questionnaire, Eosinophilic Esophagitis Activity Index, and eos/hpf was analyzed with nonparametric correlations. In nondilated patients, the association between baseline eos/hpf and symptoms was moderate and significant, although it was abolished in dilated patients. Dilation modifies association between symptoms and eos/hpf (clinicaltrials.gov NCT02019758).

The aim of this study was to evaluate Dysphagia Days as a measure of symptom improvement in patients with eosinophilic esophagitis from the HEROES study. Dysphagia Days, defined as a yes answer to the following question: During any meal today, did food go down slowly or get stuck in your throat or chest? was assessed for cendakimab vs placebo. A statistically significant reduction in the mean number of Dysphagia Days experienced was observed with cendakimab 360 mg vs placebo at week 16 (-4.67 vs -1.83; P = 0.0115); an even greater improvement was observed in steroid-refractory patients vs placebo (-4.48 vs -0.04; P = 0.0079). Dysphagia Days represents a relevant clinical end point to capture dysphagia-related symptoms.

Background Predicting fibrostenotic complications prior to endoscopy in eosinophilic esophagitis (EoE) is challenging and esophageal strictures and narrowing are commonly missed on endoscopy. Aim To develop and validate a score to predict fibrostenosis in EoE patients prior to endoscopy. Methods We leveraged a large database of newly diagnosed EoE patients. Fibrostenosis was defined as esophageal stricture, luminal narrowing, or dilation performed during the diagnostic endoscopy. Patients were randomly divided into a development and validation set. We compared features between patients with and without fibrostenosis to inform the initial model and assess predictive ability, as measured by area under curve (AUC). We tested the model in the independent validation set and generated a score to predict low, medium and high fibrostenosis risk. Results In 655 newly diagnosed EoE patients in the development set, fibrostenosis was associated with age ≥ 18 years (OR 10.64; 95% CI 5.61–20.17), symptoms for ≥ 5 years prior to diagnosis (OR 2.07; 1.32–3.24), dysphagia (OR 3.72; 1.68–8.22), food impaction (OR 1.68; 1.07–2.62), and lack of abdominal pain (OR 0.28; 0.14–0.60). The model predicted fibrostenosis (AUC = 0.841). In the validation set ( n  = 654), AUC was preserved (0.831). A scoring system was generated, with scores of ≤ 2 being low risk (< 10% chance of stricture), 2.5–4.5 medium risk (10–50% stricture), and 5–6 high risk (> 50%). Conclusions We developed and validated the PICK-UP-STRICS score to increase suspicion and detection of fibrostenotic disease in EoE using readily available clinical features prior to endoscopy. This score may guide clinical decisions on the need of endoscopic dilation.

Background A novel budesonide orodispersible tablet (BOT) has been proven effective in adult patients with active eosinophilic oesophagitis (EoE) in a 6‐week placebo‐controlled trial (EOS‐1). Aims To report the efficacy of an open‐label induction treatment with BOT in a large prospective cohort of EoE patients within the EOS‐2 study. Methods Patients with clinico‐histological active EoE were treated with BOT 1 mg BID for 6 weeks. The primary endpoint was clinico‐histological remission (≤2 points on numerical rating scales [0–10] each for dysphagia and odynophagia, and peak eosinophil count <16 eos/mm2 hpf (corresponds to <5 eos/hpf)). Further study endpoints included clinical and histological remission rates, change in the EEsAI‐PRO score, change in peak eosinophil counts, and deep endoscopic remission using a modified Endoscopic Reference Score. Results Among 181 patients enrolled, 126 (69.6%) achieved clinico‐histological remission (histological remission 90.1%, clinical remission 75.1%). The mean peak eosinophil counts decreased by 283 eos/mm2 hpf (i.e., by 89.0%). Mean EEsAI‐PRO score decreased from baseline by 29 points and deep endoscopic remission was achieved in 97 (53.6%) patients. The majority of patients judged tolerability as good or very good (85.6%) and compliance was high (96.5%). Local candidiasis was suspected in 8.3% of patients; all were of mild severity, resolved with treatment and none led to premature withdrawal from the study. Conclusions In this large prospective trial, a 6‐week open‐label treatment with BOT 1 mg BID was highly effective and safe in achieving clinico‐histological remission of active EoE and confirmed the results of the placebo‐controlled EOS‐1 trial.

Gastroesophageal reflux disease (GERD) is a very common condition characterized by chronic symptoms, such as heartburn or epigastric and/or substernal pain, that are frequently associated with mucosal damage resulting from abnormal reflux of gastric contents into the esophagus (Fass et al. in Nat Rev Dis Primers 7:55, 2021; Richter and Rubenstein in Gastroenterology 154:267–276, 2018). However, this damage can manifest in patients who do not exhibit typical GERD symptoms. Asymptomatic erosive esophagitis (AEE) is a condition in which there is esophageal mucosal injury typical for GERD, such as erosions, ulcerations, and/or Barrett’s esophagus, visible in upper endoscopy, without concurrent symptoms attributable to GERD. AEE has been challenging to study, and it is not yet clear what causes this condition. As a result, there are no definitive guidelines on how to manage it. AEE also has the potential to be very impactful on public health, as those who are affected may go years without a diagnosis, putting them at risk for a variety of complications, including strictures and even cancer. Further careful study is necessary in order to more effectively address this condition. Here, we provide a comprehensive review of the scientific literature regarding AEE, examining its prevalence, clinical characteristics, potential causes and contributing factors, as well as identifying avenues for better characterization and management of this patient population.

We previously identified 18 CpG methylation biomarkers associated with treatment response to topical corticosteroids (tCS) in eosinophilic esophagitis (EoE). In this study, in an independent cohort, we assessed the validity of these CpG sites as treatment response biomarkers. DNA was extracted from prospectively biobanked esophageal biopsies from patients with newly diagnosed EoE enrolled in a randomized trial of 2 tCS formulations. Histologic response was defined as <15 eosinophils per high-power field. Pretreatment DNA methylation was assayed on the Illumina Human MethylationEPIC BeadChip. Logistic regression and area under the receiver operating characteristic curve analyses, adjusting for chip, position on the chip, age, sex, and baseline eosinophil count, were computed to test for an association between DNA methylation and treatment response at the 18 previously identified CpG sites. We analyzed 88 patients (58 histologic responders, 30 nonresponders), with a mean age of 38 ± 16 years, 64% male, 97% White race. Of the 18 CpG sites, 13 met quality control criteria, and 3 were associated with responder status ( P < 0.012), including sites within UNC5B (cg26152017), ITGA6 (cg01044293), and LRRC8A (cg13962589). All 3 showed evidence of reduced methylation in treatment responders, consistent with the original discovery associations. The predictive probability for nonresponse with all 3 CpG sites was strong (area under the receiver operating characteristic curve = 0.79). We validated epigenetic biomarkers (CpG methylation sites) for the prediction of tCS response in patients with EoE in an independent population. While not all previously identified markers replicated, 3 demonstrated a relatively high predictive probability for response to treatment and hold promise for guiding tCS treatment in EoE.

Purpose Eosinophilic esophagitis (EoE), a chronic immune-mediated progressive disease, causes dysphagia, food impaction, abdominal pain, vomiting, and heartburn. EoE requires long-term monitoring and can affect quality of life owing to its symptoms and associated emotional and social burden. This study aimed to understand patients’ experiences with EoE. Methods Semi-structured longitudinal interviews were conducted with patients from MESSINA, a phase 3 placebo-controlled trial evaluating benralizumab for EoE. Interviews were held at two different times to assess the impact of EoE on patients’ lives before and during trial participation. Data were analyzed qualitatively to develop detailed patient profiles. Results The MESSINA trial was terminated prematurely. Of the 34 patients recruited for the first interview, 15 (44%) completed the second interview and 11 patient profiles were developed. Patients were a demographically diverse group with varying experiences. The primary reported symptom was difficulty swallowing ( n  = 11), leading to serious consequences like choking and hospitalization ( n  = 2). Other symptoms included pain when swallowing ( n  = 7), reflux ( n  = 6), and stomachache ( n  = 6). In the second interview, most ( n  = 9) patients reported moderate improvements in symptoms, while others experienced symptom recurrence or worsening. EoE had a significant negative impact on social and emotional well-being, and professional lives. Trial participation improved emotional well-being for some; however, concerns about the need for ongoing treatment were noted. Conclusion This study highlighted emotional and social burdens of EoE. The encouraging feedback on study participation underscores the importance of patient insights in developing holistic management strategies for EoE.

Eosinophilic esophagitis (EoE) is a relatively new diagnosis, where until recently a specific international classification of disease code was missing. One way to identify patients with EoE is to use histopathology codes. We validated the clinicopathological EoE diagnosis based on histopathology reports and patient charts to establish these data sources as the basis for a nationwide EoE patient cohort. Through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study, we randomly selected 165 patients from five Swedish health care regions with a histopathologic diagnosis of EoE. Patients were assigned a histopathology diagnosis of EoE if they had ≥15 eosinophils per high-power field or, in the absence of eosinophil quantification, the pathologist interpreted the biopsy as consistent with EoE. Patient charts were scrutinized to see if the other diagnostic criteria were fulfilled. Of the 131 received patient charts, 111 (85%) had sufficient information to be included in the study. Of the 111 validated patients, 99 had EoE, corresponding to a positive predictive value of 89% (95% confidence interval = 82-94%). Dysphagia was the most common symptom ( = 78, 70%), followed by food impaction ( = 64, 58%) and feeding difficulties ( = 37, 33%). Twelve patients had coexisting asthma (11%) and 16 allergic rhinitis (14%). Seventeen patients underwent esophageal dilatation (15%), of which seven had more than one dilatation. Ninety-seven (87%) patients had a proton-pump inhibitor treatment ≤2 years before or after the diagnosis. Forty-two patients (38%) had been prescribed inhalation steroids and 64 (58%) had undergone esophageal radiology. Histopathology reports from the ESPRESSO cohort with esophageal eosinophilic inflammation are suggestive of EoE.

Background Eosinophilic esophagitis (EoE) has a detrimental effect on health-related quality of life (HRQOL). The Eosinophilic Esophagitis Impact Questionnaire (EoE-IQ) is a novel patient-reported outcome (PRO) measure assessing the impact of EoE on HRQOL. To assess suitability of the EoE-IQ, its measurement properties were evaluated. Methods Using baseline and week 24 data from the pivotal, randomized, placebo-controlled, multinational phase 3 R668-EE-1774 trial (NCT03633617) of dupilumab, we evaluated EoE-IQ’s measurement properties (including reliability, construct and known-groups validity, and ability to detect change) and established the threshold for change in scores that can be considered clinically meaningful. Results The analysis population comprised 239 adults and adolescents with EoE. Mean age was 28.1 (standard deviation, 13.14) years; 63.6% were male, and 90.4% were White. Reliability estimates for the EoE-IQ average score exceeded acceptable thresholds for patients who were stable as indicated by ratings of Patient Global Impression of Severity (PGIS) and Change (PGIC) (intraclass correlation coefficients, 0.75 and 0.81). Construct validity correlations with other EoE-specific PRO scores were moderate at baseline (|r|= 0.44–0.60) and moderate to strong at week 24 (|r|= 0.61–0.72). In known-groups analysis, EoE-IQ average score discriminated among groups of patients at varying EoE severity levels defined by PGIS scores. A ≥ 0.6-point reduction in EoE-IQ average score (where scores range from 1 to 5, with higher scores indicating worse HRQOL) from baseline to week 24 can be considered clinically meaningful. Conclusions The EoE-IQ’s measurement properties are acceptable, making it a valid, reliable measure of the HRQOL impacts of EoE among adults and adolescents. Trial registration : ClinicalTrials.gov, NCT03633617. Registered August 14, 2018, https://clinicaltrials.gov/study/NCT03633617 .