Kristen Thomas

Eosinophilic oesophagitis in patients presenting with dysphagia – a prospective analysis

Background  Eosinophilic oesophagitis (EoO) may be a common finding in adults presenting with dysphagia.

Retrospective Analysis of Esophageal Food Impaction: Differences in Etiology By Age and Gender

Eosinophilic Esophagitis (EE) is an emerging cause of esophageal food impaction (EFI) not accounted for in previous studies. We sought to determine the causes of EFI in a recent cohort with recognition of EE. A retrospective chart review of all patients with EFI during the past 5 years was performed. Etiology was determined by endoscopy report, pathology results, and follow-up studies. A total of 85 EFIs occurred, in 79 patients (55 men, 30 women, age 18–100). The most common etiologies of EFI were Schatzkis ring (n=18), peptic stricture (n=18), EE (n=9), esophagitis (n=9), and no underlying diagnosis (n=20). EE was significantly more frequent in men (P < .025) and those <50 years old (P < .025). There was a significant difference in the age at which men (median age=44) and women (median age=71) present with EFI (P < .001). The etiology of EFI differs significantly by age and gender. This information may be useful in evaluation and management of EFI.

Dye-free wire-guided cannulation of the biliary tree during ERCP is associated with high success and low complication rates: outcomes in a single operator experience of 822 cases.

Background Deep biliary cannulation (DBC) is a prerequisite to most endoscopic retrograde cholangiopancreatographies (ERCPs). Numerous techniques have been described to maximize success and minimize ERCP-related complications, most notably post-ERCP pancreatitis. Dye-free cannulation by using guidewires with hydrophilic tips has been proposed as a technique with a high rate of success and a low rate of complications. We report the outcomes 822 consecutive ERCP procedures by using dye-free guidewire cannulation techniques. Objective To evaluate the success rate for DBC and rates of complications by using dye-free guidewire cannulation techniques. Design Retrospective. Consecutive ERCP procedures with intent to achieve DBC exclusively by using dye-free guidewire technique were included. Complication data on post-ERCP pancreatitis, bleeding, perforation, and cholangitis were extracted. Setting University. Patients Patients undergoing biliary ERCP. Interventions ERCP. Main Outcome Measurements Success, complication rates. Results Eight hundred and twenty-two ERCPs were performed on 744 patients. Five hundred and fifty-nine (68%) procedures were performed on inpatients, 263 (32%) on outpatients. DBC was successful in 801 of 822 (97%) ERCPs. In 795 of 801 (99%) ERCPs with successful DBC procedures, DBC was achieved in a dye-free fashion. Eleven patients (1.3%) developed post-ERCP pancreatitis—all cases were mild. Guidewire perforations occurred 11 times (1.3%), none required surgery. Ten of 11 patients with known or suspected (91%) guidewire perforation achieved successful DBC on repeat ERCP by the same endoscopist by using dye-free techniques. Limitations Retrospective. Conclusions In this large retrospective case series, a high success rate of DBC was achieved by using dye-free guidewire techniques. This technique has associated lower rates of complications in comparison to those reported earlier.

Endoscopic Celiac Plexus Blockade Via Direct Intraneuronal Injection Versus Perineuronal Injection: Results of a Pilot Study

Endoscopic Celiac Plexus Blockade Via Direct Intraneuronal Injection Versus Perineuronal Injection: Results of a Pilot Study

Airway and esophageal eosinophils in children with severe uncontrolled asthma

Children with severe uncontrolled asthma (SUA) have a high burden of symptoms and increased frequency of asthma exacerbations. Reflux esophagitis and eosinophilic esophagitis are important co‐morbid factors for SUA. Both are associated with the presence of eosinophils in esophageal mucosa. We hypothesized that esophageal eosinophils are frequently present and correlate with the presence of airway eosinophils in children with SUA.

S1858 Eosinophil Degranulation Differentiates Eosinophilic Esophagitis (EoE), Possible EoE and GERD Patients

for each feature). EE patients also had significantly higher epithelial scores (mean of 7.33 as compared to 0.52 in GERD, p<0.001) and higher LP maximum scores (mean 4.5 versus 1 in GERD, p<0.001). Epithelial histologic features correlated well with endoscopic features of furrows/thickening, plaques, and pallor (r=0.62-0.82, p<0.001 for each) while LP scores correlated best with the endoscopic feature of thickening/furrows (r=0.64, p=0.002). Symptom complaints of dysphagia + anorexia/early satiety correlated best with epithelial scores (r=0.32, p=0.01); dysphagia correlated best with LP scores (r=0.45, p=0.04). None of the other symptoms assessed correlated with histologic or endoscopic findings. Conclusion: EE patients have significantly more severe endoscopic and histologic changes as compared with GERD patients. The objective endoscopic and epithelial/LP histologic features correlate well with one another. However, of subjective complaints, only dysphagia and anorexia/early satiety correlate with histologic and endoscopic findings.

S1873 True/False: Eosinophilic Esophagitis (EoE) Responds to Acid Suppression

Introduction: Refractory GERD describes those patients who continue to have symptoms despite treatment with proton-pump inhibitors (PPI)1. The participation of eosinophilic esophagitis (EE) in the refractory GERD has been scarcely studied. When both disorders are simultaneously present, the clinical, endoscopic and histologic findings may be nonspecific and as such the overlap of refractory GERD and EE has been matter of debate. Aim: To study the occurrence of EE in patients with refractory GERD. Methods: Upper digestive endoscopies (UDE) were performed, obtaining mucosal biopsies of distal, middle and lower esophagus and stomach (body and antrum) in 97 adult consecutive patients. Erosive esophagitis was classified according to Los Angeles classification. Seventy three (75.3%) were female, with mean age of 44,4 (+ 9.09) of years. Eighty seven patients (89.6%) were submitted to esophageal manometry and pHmetry. The patients (82, 84%) have been receiving high doses of PPI (40 mg omeprazol b.i.d.) for at least 6 weeks. The main complaint was heartburn and regurgitation. The diagnosis of GERD was based on UDE and pHmetry. The diagnosis of EE was based on the presence of ≥20 eosinophils per high power field (eo/hpf) in the esophageal biopsies. Results: UDE was normal in 78 patients (81%). Erosive esophagitis (grade A in 9, B in 2 and C in 2 of LA) was found in 13 (13%) patients. All the others 6 (6%) were classified as non-erosive esophagitis (NERD). One patient ( 1 %) presented > 20 eo/hpf. In 25 (27.8%) patients the pHmetry was altered during PPI treatment (80 mg/day). The manometry showed hypomotility before the treatment for EE and, inespecific motor disturbances after the decreasing of eosinophils post the appropriate treatment. Conclusions: There was a very low prevalence of EE in patients with refractory GERD. (1) Spechler SNat Clin Pract Gastroenterol Hepatol, 2007

S1872 Acid-Induced Injury Does Not Enhance Local Changes of Eosinophilic Esophagitis: An Analysis of 11 Histologic Findings

Introduction: Refractory GERD describes those patients who continue to have symptoms despite treatment with proton-pump inhibitors (PPI)1. The participation of eosinophilic esophagitis (EE) in the refractory GERD has been scarcely studied. When both disorders are simultaneously present, the clinical, endoscopic and histologic findings may be nonspecific and as such the overlap of refractory GERD and EE has been matter of debate. Aim: To study the occurrence of EE in patients with refractory GERD. Methods: Upper digestive endoscopies (UDE) were performed, obtaining mucosal biopsies of distal, middle and lower esophagus and stomach (body and antrum) in 97 adult consecutive patients. Erosive esophagitis was classified according to Los Angeles classification. Seventy three (75.3%) were female, with mean age of 44,4 (+ 9.09) of years. Eighty seven patients (89.6%) were submitted to esophageal manometry and pHmetry. The patients (82, 84%) have been receiving high doses of PPI (40 mg omeprazol b.i.d.) for at least 6 weeks. The main complaint was heartburn and regurgitation. The diagnosis of GERD was based on UDE and pHmetry. The diagnosis of EE was based on the presence of ≥20 eosinophils per high power field (eo/hpf) in the esophageal biopsies. Results: UDE was normal in 78 patients (81%). Erosive esophagitis (grade A in 9, B in 2 and C in 2 of LA) was found in 13 (13%) patients. All the others 6 (6%) were classified as non-erosive esophagitis (NERD). One patient ( 1 %) presented > 20 eo/hpf. In 25 (27.8%) patients the pHmetry was altered during PPI treatment (80 mg/day). The manometry showed hypomotility before the treatment for EE and, inespecific motor disturbances after the decreasing of eosinophils post the appropriate treatment. Conclusions: There was a very low prevalence of EE in patients with refractory GERD. (1) Spechler SNat Clin Pract Gastroenterol Hepatol, 2007