Hamish Philpott

Randomised clinical trial: the efficacy of gut‐directed hypnotherapy is similar to that of the low FODMAP diet for the treatment of irritable bowel syndrome

A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet is effective in treating irritable bowel syndrome (IBS).

A prospective open clinical trial of a proton pump inhibitor, elimination diet and/or budesonide for eosinophilic oesophagitis.

Elimination diets and high‐dose proton pump inhibitors (PPI) are advocated as first‐line treatments in patients with eosinophilic oesophagitis (EoE).

Allergy tests do not predict food triggers in adult patients with eosinophilic oesophagitis. A comprehensive prospective study using five modalities

The use of allergy tests to guide dietary treatment for eosinophilic oesophagitis (EoE) is controversial and data are limited. Aeroallergen sensitisation patterns and food triggers have been defined in Northern Hemisphere cohorts only.

Seasonal recurrence of food bolus obstruction in eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a newly recognised condition that is apparently increasing in prevalence, and the aetiology is poorly understood. The role of aeroallergens in EoE is controversial, given the success of dietary therapy. Massive aeroallergen exposure leading to food bolus obstruction events (FBOE) has been described, and the diagnosis of EoE by esophageal biopsy noted to be more common in the pollen season according to previous case series.

Prevalence and characteristics of men with eating disorders in primary care: how do they compare to women and what features may aid in identification?

Objectives: Little is known about men with eating disorders (EDs) in primary care. The present study objectives were to (i) assess ED prevalence, ED features, weight, co-morbidities, exercise patterns, sexual orientation, and help-seeking in men attending a general practice setting and (ii) compare the results with a similar study of women. Method: Five hundred men chosen randomly from two general practices were screened with the Eating Disorders Examination-Questionnaire (EDE-Q), with an extra question concerning exercise for weight or shape control. Subsequently 50 subjects were interviewed to confirm psychiatric diagnoses and assess clinical features, weight, help-seeking for EDs and exercise. Results: The prevalence of eating disorders was 1.2% (0 to 3.2 95% CI), most being Eating Disorders Not Otherwise Specified (EDNOS) of a bulimic type. This was significantly lower than the prevalence of eating disorders in the female study (χ2=12.91, df=1, P< 0.001). Men with EDs had frequent psychiatric co-morbidity. Eating disorder phenomenology was similar between the genders except that men were less weight concerned or likely to have self-induced vomiting. Men were also less likely to seek treatment. Conclusions: As with women, better definition of EDNOS syndromes may help in recognition of men with EDs.

Eosinophilic fasciitis as a paraneoplastic phenomenon associated with metastatic colorectal carcinoma.

A 72‐year‐old man presented with erythema and induration of his calves and forearms. He had a past history of stage 1 colorectal carcinoma, treated with resection and primary anastamosis 4 years earlier. A diagnosis of eosinophilic fasciitis was made based on the characteristic clinical appearance, peripheral blood eosinophilia and a skin biopsy. There was no improvement in the condition following treatment with prednisolone or methotrexate. One year later, abnormal liver function studies were noted, and an abdominal computed tomography scan and subsequent needle biopsy of the liver confirmed a neoplastic lesion in the liver consistent with a metastatic colorectal carcinoma. Systemic chemotherapy with oxaliplatin, 5‐fluorouracil and capecitabine was commenced, and resulted in partial remission of the colorectal carcinoma. Simultaneously, the indurations of the forearms and calves also improved, suggesting that the eosinophilic fasciitis was a paraneoplastic phenomenon.

Eosinophilic esophagitis: a clinicopathological review.

Eosinophilic esophagitis (EoE) is considered to be a chronic antigen-driven disease whereby food and/or aeroallergens induce a chronic inflammatory infiltrate in the esophagus, resulting in pathological hyperplasia of the epithelia and muscular layers, and fibrosis of the lamina propria (referred to collectively as remodelling) and the symptoms of dysphagia and food impaction. EoE shares features with other atopic conditions of asthma and atopic dermatitis, such as a TH2 cytokine milieu and a mixed inflammatory infiltrate of eosinophils, mast cells and lymphocytes. Relatively distinct features include the strong male predominance amongst adult patients, and the expression of the eosinophil chemokine eotaxin 3. Current first line treatments such as strict dietary modification and corticosteroids fail many patients. Looking forward, clarification of distinct genotype/phenotype associations, determining the reversibility of remodelling following treatment, and the development of new pharmacotherapies that target fibrotic pathways (as opposed to eosinophilic inflammation per se) or specifically improve barrier integrity appear relevant.

Ultrathin unsedated transnasal gastroscopy in monitoring eosinophilic esophagitis

Ultrathin unsedated transnasal gastroscopy (UTEG) has a number of advantages applicable to eosinophilic esophagitis (EoE) and has not been evaluated for this condition.

What we have here is a failure to communicate! Improving communication between tertiary to primary care for chronic heart failure patients

Background:  The aims of this study were to determine the documentation of pharmacotherapy optimization goals in the discharge letters of patients with the principal diagnosis of chronic heart failure.

Chronic urticaria: the autoimmune paradigm

Chronic urticaria is a disease consisting of spontaneous pruritic welts, present on all or most days for more than 6 weeks. It is commonly supposed to be allergic in origin, although allergy is not the cause in the majority of cases, and it has therefore been termed ‘chronic idiopathic urticaria’. Recent evidence indicates that at least a subset of patients in whom no extrinsic or internal cause can be identified are in fact autoimmune in origin. This is based mainly on the detection of pathogenic autoantibodies to the high‐affinity immunoglobulin E receptor FcɛR1, which are thought to activate cutaneous mast cells. In this article, we review the evidence that has given rise to this autoimmune ‘paradigm’ and its impact on diagnosis and management.